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Journal articles on the topic 'Open flap debridement'

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Published: 9 March 2023
Last updated: 10 March 2023

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1

Cao, Zheming, Cheng Li, Jiqiang He, Liming Qing, Fang Yu, Panfeng Wu, and Juyu Tang. "Early Reconstruction Delivered Better Outcomes for Severe Open Fracture of Lower Extremities: A 15-Year Retrospective Study." Journal of Clinical Medicine 11, no. 23 (December 2, 2022): 7174. http://dx.doi.org/10.3390/jcm11237174.

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Background: The principle of early flap reconstruction for high-grade traumatic lower-extremity injuries established in 1986 by Godina has been widely accepted. However, the lack of an orthoplastic center in China makes early reconstruction not accessible for all patients with a Gustilo IIIB fracture. This study aimed to analyze the impact of timing on outcomes in lower-extremity traumatic free-flap reconstruction. Methods: A retrospective review identified 394 free-flap reconstructions performed from January 2005 to January 2020 for Gustilo IIIB tibial fractures. Patients were stratified based on the number of debridements: two times or less (early) and more than two times (delayed). The interval between injury and reconstruction, surgery time, hemorrhage volume, length of hospitalization (LoS), wound and bone healing time, flap outcomes, and function restoration were examined based on times of debridement. Results: The mean interval between injury and flap reconstruction in the early-repair group with 6.15 ± 1.82 postoperative days (PODs) was significantly shorter than that of the delayed-repair group with 16.46 ± 4.09 PODs (p < 0.001). The flap harvest time, reconstructive time, and intraoperative blood loss were also significantly less in the early-repair group compared to the delayed-repair group. Interestingly, we observed an 8.20% enlargement of wound size due to multiple debridements in the delayed-repair group. Most importantly, the early-repair group had better outcomes with a decreased risk of total or partial flap necrosis, lower incidence of flap complications, and fewer overall late complications than the delayed-repair group. In addition, the LoS, as well as wound and bone healing time, were notably shorter in the early-repair group. Furthermore, 4.85% of cases in the delayed-repair group experienced additional operations on bone, while no additional operations were performed in the early-repair group. All cases in both groups obtained satisfying functional results, while the early-repair group showed better functional recovery. Conclusions: Early repair with free flaps performed within two instances of debridement had superior outcomes when compared with delayed reconstruction after multiple debridements, consistent with Godina’s findings. We recommended early referral to a higher-level hospital with orthoplastic capabilities after an aggressive and thorough initial debridement carried out by senior surgeons.
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2

Thapa, Bishwamber, Prakash Sitoula, Ranjib Kumar Jha, Santosh Thapa, Suman Kunwar, and Ashish Rajthala. "Outcome of Soft Tissue Coverage in Open Tibia Fractures with Non-Microvascular Flap at a Tertiary Care Hospital." Journal of Nobel Medical College 11, no. 1 (June 29, 2022): 22–26. http://dx.doi.org/10.3126/jonmc.v11i1.45731.

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Background: Open tibia fractures are high energy injuries often associated with large soft defects, extensive soft tissue stripping and contamination requiring multiple debridement procedures. Collective ortho-plastic approach helps us achieve proper debridement, adequate fixation and early soft tissue coverage. Due to fairly high incidence of failure, steep learning curve, time consuming procedure and the cost of treatment for those tedious free flaps, non-microvascular flaps are being preferred to cover the soft tissue defects or exposed hardware in open tibia fractures. Materials and Methods: A prospective study was carried out in 19 patients to assess the outcome of soft tissue coverage in open tibia fractures with non-microvascular flap. Out of these patients, 6 patients were treated with medial gastrocnemius flap, 5 patients with medial hemi-soleus, 5 patients with reverse sural fasciocutaneous flap, and 3 patients with local rotational random flaps. Outcome measures included bony union, deep surgical infection and flap failure. Results: 84% patients were male whereas 16% patients were female. Road traffic accident was the major cause of the defect among the patients (74%). Complications in the form of deep infection (10%), non-union (21%), delayed union (10%) and marginal flap necrosis (21%) were observed. Conclusion: In our study, early soft tissue coverage with appropriate non-microvascular flaps in management of severe open fractures of tibia was associated with more favourable outcomes.
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Meena, Mahaveer, Vikas Chavan, Sanjay Kumar Ghilley, and Nilesh Kumar Jangir. "Soft tissue coverage techniques for management of open fractures of tibia (type IIIB)." International Journal of Research in Orthopaedics 6, no. 4 (June 23, 2020): 773. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20202683.

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<p class="abstract"><strong>Background:</strong> Open fractures are surgical emergencies; incidence of open fractures is increasing with more high-energy road traffic accidents. The tibia is exposed to frequent injury because of its location. The need for aggressive debridement, adequate fracture fixation, and early flap coverage in reducing the morbidity cannot be over emphasized.</p><p class="abstract"><strong>Methods:</strong> Treatment of open fracture by immediate debridement and anatomical fracture reduction using external fixator device. Gastrocnemius muscle flap done in upper 1/3 open fractures (type IIIB) with larger defects along with split thickness skin graft (STSG). In middle and lower 1/3 open fractures (type IIIB), fasciocutaneous and soleus muscle flaps done with relatively smaller soft tissue defects and exposed bone with STSG.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 15 patients with open tibia fracture Gustillo Anderson type IIIB classified after the initial debridement. Excellent flap takes up was seen in all cases. 11 cases (73.3%) achieved union at the end of 6 months follow-up while 4 cases (26.7%) showed delayed union which required additional procedures like BMI or bone graft.</p><p class="abstract"><strong>Conclusions:</strong> Soft tissue coverage techniques like fascicutaneous flap, gastrocnemius and soleus muscle flap had a definitive role in the management of open fractures of tibia (type IIIB).</p>
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4

Gorkhali, Ranjita Shrestha, Shaili Pradhan, Rejina Shrestha, Shweta Agrawal, Krishna Lamicchane, Pramod Kumar Koirala, and Benju Shrestha. "Evaluation of Bovine Derived Xenograft Combined with Bioresorbable Collagen Membrane in Treatment of Intrabony Defects." Journal of Nepalese Society of Periodontology and Oral Implantology 4, no. 2 (December 31, 2020): 61–67. http://dx.doi.org/10.3126/jnspoi.v4i2.34231.

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Introduction: Treatment of periodontal diseases done by surgical therapy depends upon extent and severity of disease. The ultimate goal of periodontal reconstructive surgery is to regenerate tissues destroyed during periodontal disease. Objective: To evaluate the effectiveness of bovine-derived xenograft with collagen membrane in treatment of intrabony defects by comparing it with open flap debridement alone. Methods: This non-randomised controlled trial was conducted after ethical clearance, at Bir hospital from 2018 March to 2019 April. The study recruited 38 patients by convenience sampling, age from 25-44 years, with chronic periodontitis, and willing to sign informed consent. Intrabony defects were treated by open flap debridement with bovine-derived xenograft and bioresorbable collagen membrane (Test group) and open flap debridement alone (Control group). Probing pocket depth, clinical attachment level, gingival recession, oral hygiene status, and gingival status were assessed at baseline and six months. Results: Six months after therapy, in Test group probing pocket depth reduction was 5.2 mm and gain in mean clinical attachment level was 4.3 mm. In Control group, mean probing pocket depth reduction was 3.8 mm and mean gain in clinical attachment level was 2.7 mm. The test treatment resulted in statistically higher probing pocket depth reduction and clinical attachment level gain than Control group. Conclusion: Both therapies resulted in significant probing pocket depth reductions and clinical attachment gains, and treatment with open flap debridement with bovine-derived xenografts and collagen membrane resulted in significantly higher probing pocket depth reduction and clinical attachment gain than treatment with open flap debridement alone.
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5

Gupta, M., AK Lamba, M. Verma, F. Faraz, S. Tandon, K. Chawla, and DK Koli. "Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser." Australian Dental Journal 58, no. 1 (February 27, 2013): 41–49. http://dx.doi.org/10.1111/adj.12021.

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6

Ramadhany, Eka Pramudita, Al Sri Koes Soesilowati, and Sri Pramestri Lastianny. "Effect of sandwich bone augmentation using hydroxyapatite and demineralized freeze- dried bone on infrabony pocket treatment." Majalah Kedokteran Gigi Indonesia 5, no. 3 (February 27, 2020): 114. http://dx.doi.org/10.22146/majkedgiind.37427.

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Periodontitis is periodontal inflammation in response to plaque bacterial antigens, causing damage to periodontal ligament and alveolar bone resorption. Bone graft material combination i.e. demineralized freeze-dried bone allograft (DFDBA) and hydroxyapatite (HA) using sandwich bone augmentation (SBA) method will support each other and will be beneficial to be used as a scaffold. The body takes long time to resorb HA so this could complement DFDBA which is more easily dissolved. This study aimed to reveal the effect of bone graft addition using SBA method on the treatment of infrabony pocket with open flap debridement in terms of probing depth, relative attachment loss, alveolar bone height, and density. This study was carried out to 20 infrabony pockets, where 10 of them were treated using open flap debridement with HA addition, while the other 10 groups were treated using open flap debridement with DFDBA and HA using SBA method. Probing depth and relative attachment loss were measured on days 0, 30 and 90. Bone height and density were measured using cone-beam computed tomography (images on day 0 and 90). The study showed that probing depth reduction on SBA group was greater than HA group. There were significant differences in probing depth and relative attachment loss examinations. However, bone height and bone density reduction did not show any significant difference. The conclusion from this study is open flap debridement using SBA method yields better regeneration in terms of probing depth and relative attachment loss than open flap debridement with HA addition. There is no difference in bone height and bone density between the two groups.
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7

Bruce, Jeffrey N., and Samuel S. Bruce. "Preservation of bone flaps in patients with postcraniotomy infections." Journal of Neurosurgery 98, no. 6 (June 2003): 1203–7. http://dx.doi.org/10.3171/jns.2003.98.6.1203.

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Object. Management of postcraniotomy wound infections has traditionally consisted of operative debridement and removal of devitalized bone flaps followed by delayed cranioplasty. The authors report the highly favorable results of a prospective study in which postcraniotomy wound infections were managed with surgical debridement to preserve the bone flaps and avoid cranioplasty. Methods. Since 1990, 13 patients with postcraniotomy wound infections have been prospectively treated with open surgical debridement and replacement of the bone flap. All patients received a full course of systemic antibiotic agents based on the determination of the bacterial culture and antibiotic sensitivity. Notable risk factors for infection included prior craniotomies, radiotherapy, and skull base procedures. The mean long-term follow-up period was 35 × 20 months. In all five patients who underwent craniotomies without complications, bone flap preservation was possible with full resolution of the infection and without the need for additional surgery. Among the eight patients with risk factors, bone preservation was possible in six patients, although two required minor wound revisions (without bone flap removal). Both patients who underwent craniofacial procedures required an additional procedure in which the bone flap was removed for recurrent infection (one after 2 months and the other after 29 months). Conclusions. In patients with uncomplicated postcraniotomy infections, simple operative debridement is sufficient and it is not necessary to discard the bone flaps and perform cranioplasties. Even patients with risk factors such as prior surgery or radiotherapy can usually be treated using this strategy. Patients who undergo craniofacial surgeries involving the nasal sinuses are at higher risk and may require bone flap removal.
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8

Zigdon, Hadar, Liran Levin, Margarita Filatov, Orit Oettinger-Barak, and Eli E. Machtei. "Intraoperative Bleeding During Open Flap Debridement and Regenerative Periodontal Surgery." Journal of Periodontology 83, no. 1 (January 2012): 55–60. http://dx.doi.org/10.1902/jop.2011.110182.

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9

Yukna, Raymond A. "Osseous defect responses to hydroxylapatite grafting versus open flap debridement." Journal of Clinical Periodontology 16, no. 7 (August 1989): 398–402. http://dx.doi.org/10.1111/j.1600-051x.1989.tb01667.x.

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10

Bhavani, Peddireddy. "Soft Tissue Healing and IL-6 Cytokine Levels in Microsurgical and Conventional Open Flap Debridement in Patients with Chronic Periodontitis - A Randomized Clinico-Biochemical Trial." Journal of Evolution of Medical and Dental Sciences 10, no. 34 (August 23, 2021): 2928–33. http://dx.doi.org/10.14260/jemds/2021/597.

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BACKGROUND The present study was conducted to compare clinical outcomes and gingival crevicular fluid (GCF) interleukin (IL)-6 cytokine levels in microsurgical and conventional open flap debridement procedure. METHODS Thirty sites in chronic periodontitis patients were randomly assigned into Group I (microsurgical) and Group II (conventional) open flap debridement in a split-mouth design. Gingival bleeding index (GBI), probing pocket depth (PPD), relative attachment level (RAL) were recorded at baseline and 3 months. GCF IL-6 cytokine levels were assessed at baseline and on 3rd day postoperatively. Pain perception using visual analog score (VAS) and soft tissue healing using early healing index (EHI) were assessed after on 7th day post-surgery. RESULTS There was a significant reduction in gingival bleeding index, probing pocket depth, relative attachment level within both the groups. Intergroup gingival bleeding index scores were statistically significant at the end of 3 months. The difference in visual analog scores between the two groups was found to be statistically insignificant whereas early healing index scores between the groups was found to be statistically significant. Group I showed lower levels of IL-6 on 3rd day postoperatively. It was also found that there was positive correlation of IL-6 levels with clinical parameters such as PPD and RAL. CONCLUSIONS Open flap debridement using microsurgical approach can substantially improve clinical parameters and wound healing compared with conventional macrosurgical approach. IL-6 levels were lower in microsurgical group indicating less invasive surgical approach. KEY WORDS Open Flap Debridement, Periodontal Microsurgery, Wound Healing, IL-6, Cytokine, GCF.
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11

Crea, Alessandro, Giorgio Deli, Cristiano Littarru, Carlo Lajolo, Gianluca Vittorini Orgeas, and Dimitris N. Tatakis. "Intrabony Defects, Open-Flap Debridement, and Decortication: A Randomized Clinical Trial." Journal of Periodontology 85, no. 1 (January 2014): 34–42. http://dx.doi.org/10.1902/jop.2013.120753.

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12

Huerzeler, M. B., F. T. Einsele, M. Leupolz, U. Kerkhecker, and J. R. Strub. "The effectiveness of different root debridement modalities in open flap surgery." Journal of Clinical Periodontology 25, no. 3 (March 1998): 202–8. http://dx.doi.org/10.1111/j.1600-051x.1998.tb02429.x.

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13

La Monaca, Gerardo, Nicola Pranno, Susanna Annibali, Iole Vozza, and Maria Paola Cristalli. "Subcutaneous Facial Emphysema Following Open-Flap Air-Powder Abrasive Debridement for Peri-Implantitis: A Case Report and an Overview." International Journal of Environmental Research and Public Health 18, no. 24 (December 16, 2021): 13286. http://dx.doi.org/10.3390/ijerph182413286.

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Subcutaneous facial emphysema related to dental treatments is a well-known clinical complication due to incidental or iatrogenic air or gas penetration into the subcutaneous tissues and fascial planes, leading to distension of the overlying skin. To the best of our knowledge, from 1960 to the current date, only six cases have been reported arising from peri-implant cleaning or non-surgical peri-implantitis treatment. Therefore, the present case of subcutaneous facial emphysema following open-flap air-powder abrasive debridement was the first report during surgical peri-implantitis therapy. Swelling on the left cheek and periorbital space suddenly arose in a 65-year-old woman during open-flap debridement with sodium bicarbonate air-powder abrasion (PROPHYflex™ 3 with periotip, KaVo, Biberach, Germany) of the infected implant surface. The etiology, clinical manifestations, diagnosis, potential complications, and management of subcutaneous emphysema are also briefly reviewed. The present case report draws the attention of dental practitioners, periodontists, oral surgeons, and dental hygienists to the potential iatrogenic risk of subcutaneous emphysema in using air-powder devices in implant surface debridement.
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Perumal, MeenaPriya Bagavathy, ArunaDunthur Ramegowda, AvinashJanaki Lingaraju, and JamesJohnson Raja. "Comparison of microsurgical and conventional open flap debridement: A randomized controlled trial." Journal of Indian Society of Periodontology 19, no. 4 (2015): 406. http://dx.doi.org/10.4103/0972-124x.156884.

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15

Petsos, Hari, Petra Ratka‐Krüger, Erik Neukranz, Peter Raetzke, Peter Eickholz, and Katrin Nickles. "Infrabony defects 20 years after open flap debridement and guided tissue regeneration." Journal of Clinical Periodontology 46, no. 5 (May 2019): 552–63. http://dx.doi.org/10.1111/jcpe.13110.

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16

Abullais, Shahabe, Gore Anoop, Nitin Dani, Saad Al-qahatani, Ashfaq Yaqoob, Abdul Khan, and Mohammed Kade. "Assessment of supracrestal tissue attachment variation in patients with chronic periodontitis before and after treatment: A clinical-radiographic study." Vojnosanitetski pregled 77, no. 11 (2020): 1175–83. http://dx.doi.org/10.2298/vsp181118007a.

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Background/Aim. Healthy periodontium comprises the dento-gingival junction. Periodontal disease starts to appear when the integrity of the junctional epithelium is disturbed. Assessment of the supracrestal tissue attachment (SCTA) is essential because there is a frequent need for restoration or prosthesis after periodontal surgical and non-surgical therapy. The aim of the present study was to evaluate the SCTA variations in a patients with chronic periodontitis before and after treatment. Methods. Thirty systemically healthy patients with periodontitis were enrolled in the study. Fifteen patients were subjected to scaling and root planing and 15 to open flap debridement. Radiographic and clinical findings of the SCTA were assessed before and after treatment at 3-month and 6-month intervals. Results. Comparison between clinical and radiographic findings of the SCTA showed a significant difference in patients with periodontitis (p < 0.05). This difference was not significant after treatment of patients with shallow pockets with scaling and root planing (p > 0.05), but showed a significant difference in patients with moderate pockets treated by open flap debridement (p < 0.05). Conclusion. Progression in periodontal disease causes a reduction in the SCTA dimension, which regains its original dimensions after periodontal therapy. It takes around 3 months for the shallow pockets to regain the supracrestal tissue attachment to the original dimension when treated by scaling and root planing, whereas moderate pockets regain it after 6 months when treated with open flap debridement.
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Serafini, Maurizio, and Sara Di Teodoro. "Surgical Periodontal Treatment: A Case Report." Journal of Stem Cells Research, Development & Therapy 8, no. 1 (June 10, 2022): 1–7. http://dx.doi.org/10.24966/srdt-2060/100090.

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Periodontal disease affects patient's health worsening people's quality of life. This clinical case reports the treatment of a 45 years old patient with periodontitis including open flap debridement in first and fourth quadrant and laser treatment on second quadrant
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18

Karn, Binod. "The Use of Gastrocnemius Muscle Flap in Reconstruction of Pretibial Defects." Journal of Nepalgunj Medical College 12, no. 1 (September 17, 2015): 2–5. http://dx.doi.org/10.3126/jngmc.v12i1.13396.

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Background: In Western part of Nepal the post traumatic lower leg and bone injuries with infected, open wound is common occurrence.Aim: It was to find out whether Gastrocnemius muscle flap is a viable option for pretibial defects. However variations in vascular anatomy of pedicle, use of reverse flow soleus muscle flap based on posterior tibial artery, leads to high failure rate and sacrificing major leg vessels.Method: Use of soleus muscle flap supported by perforating arteries, branches of posterior tibial vessels is option to cover small defects. The flap with careful newer modification to preserve vascularity, is used in 32 cases of pretibial defects.Observation: All 32 flaps survived with two cases in post operative phase, needing a flap elevation debridement of underlying bone and other skin grafting.Result: None of the case showed any vascular insufficiency, graft muscle loss or any functional loss. Use of muscle flap a viable option in pretibial defects.Journal of Nepalgunj Medical College Vol.12(1) 2014: 2-5
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19

Karikalan, T. "Flaps in the management of open tibial fractures." International Journal of Research in Orthopaedics 5, no. 3 (April 26, 2019): 504. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20191792.

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<p class="abstract"><strong>Background:</strong> The prognosis in open fractures is primarily determined by the amount of soft tissue loss and the level of contamination. Severe open tibial fractures usually require combined orthoplastic approach in the management. Our aim is to study the effectiveness of soft tissue flaps in the management of type III B open tibial fractures.</p><p class="abstract"><strong>Methods:</strong> The study material consists of 20 cases of grade III B open tibial fractures admitted in our institution. Under anaesthesia, wound debridement was done and fracture stabilised with external fixator or IM nail depending upon the wound status. Patient underwent flap cover once the wound was fit. Periodic follow up was done.<strong></strong></p><p class="abstract"><strong>Results:</strong> Nonunion occurred in one patient (5%). Chronic osteomyelitis developed in two patients (10%). Deep infection occurred in three cases (15%). There was no secondary amputation in our series. The average union time of fracture was 30.1 weeks. Lower third fractures and those patients with extensive soft tissue injury, delayed flap cover and flap failure had longer union time.</p><p class="abstract"><strong>Conclusions:</strong> Fasciocutaneous flap has definitive role in the management of type III B open tibial fractures with soft tissue loss.</p><p class="abstract"> </p>
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Hong, Joon Shik, Young Woong Mo, Inho Kang, Gyu Yong Jung, Hea Kyeong Shin, and Joon Ho Lee. "Treatment of Chronic Lower Extremity Wound Complicated by Osteomyelitis: Using Partial Biceps Femoris Muscle Flap." Journal of Wound Management and Research 17, no. 2 (June 30, 2021): 135–40. http://dx.doi.org/10.22467/jwmr.2020.01214.

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In many cases chronic wounds in the lower extremities are extremely difficult to heal because of inadequate blood supply, and when wounds are complicated by osteomyelitis, plastic surgeons and orthopedic surgeons must join forces to facilitate treatment. A 63-year-old man with bone exposure and a peripherally indurated chronic open wound complicated by osteomyelitis of the right distal thigh was admitted to the department of orthopedic surgery at our hospital. He was referred to our department for treatment of the right side chronic open wound. We report our successful experience with a partial biceps femoris muscle transposition flap with fasciocutaneous expanded-keystone advancement flap following wound and bone debridement for the coverage of complex wounds associated with bone infection. The results show two discrete layers of muscle. In patients with chronic osteomyelitis, fasciocutaneous flaps might provide a more effective means of covering full-depth soft tissue defects without donor site morbidity, compared to free flaps.
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Robicsek, Francis. "Postoperative Sterno-Mediastinitis." American Surgeon 66, no. 2 (February 2000): 184–92. http://dx.doi.org/10.1177/000313480006600215.

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Postoperative sterno-mediastinitis is a life-threatening complication that occurs in about 0.75 to 1.4 per cent of all open heart operations. The result of treatment largely depends on timely diagnosis and appropriate surgical management. Risk factors for infection should be corrected preoperatively whenever possible. Among other preventive measures, meticulous asepsis, atraumatic surgical technique, preserving the blood supply and the mechanical integrity of the sternum, prevention of sternal instability, and correction of the same if it occurs are the most important. The management of sterno-mediastinitis should be tailored to the individual clinical features of the patients. Clearly cases with nonpurulent sternomediastinitis and no soft tissue or bone necrosis (type 1) may be treated with reopening, drainage, sternal stabilization, and primary closure. Virulent infections with tissue necrosis (type II) may be best handled with reopening, several days of open management, and debridement then secondary closure with viable tissue (usually muscle) flaps. Chronic, smoldering infections (type III) are usually managed with debridement and muscle-flap coverage.
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Becker, William, Burton E. Becker, Lawrence Berg, and Ciamek Samsam. "Clinical and Volumetric Analysis of Three-Wall Intrabony Defects Following Open Flap Debridement." Journal of Periodontology 57, no. 5 (May 1986): 277–85. http://dx.doi.org/10.1902/jop.1986.57.5.277.

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Nickles, Katrin, Petra Ratka-Krüger, Eric Neukranz, Peter Raetzke, and Peter Eickholz. "Open flap debridement and guided tissue regeneration after 10 years in infrabony defects." Journal of Clinical Periodontology 36, no. 11 (November 2009): 976–83. http://dx.doi.org/10.1111/j.1600-051x.2009.01474.x.

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Irsyam, OK Ilham Abdullah, Saraswati Hastika, Hendra Hendra, Andrew Budiartha Budisantoso, and Tesar Akbar Nugraha. "VACUUM-ASSISTED CLOSURE AND MUSCLE FLAP AS AN ALTERNATIVE MODALITY FOR INFECTED WOUND AFTER ORIF OF TIBIAL FRACTURE: CASE REPORT." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 11, no. 1 (April 28, 2022): 16–21. http://dx.doi.org/10.20473/joints.v11i1.2022.16-21.

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Background: The blood supply of a bone can be decreased due to the use of an implant, leading to wound-bed bacterial colonization and the development of the SSI. The principle of vacuum-assisted closure (VAC) is to use a negative pressure environment in the wound to promote increased wound healing. The case shows that VAC application and muscle flap therapy provide the definitive healing of infected wounds after ORIF. Case Report: A 45 years-old male presented with a close comminuted proximal third right tibia fracture and tense skin. The fracture was openly reduced and internally fixated with plate fixation and a skin flap on the fracture area. Still, the wound could not be closed due to difficulty covering the wound, so a counter incision was made. After four days, the patient developed necrosis in the post-operation wound and subsequently underwent debridement and muscle flap with VAC application. Discussion: SSI can be treated by applicating of appropriate antibiotic and surgical procedures. In this case, the infection was treated using third-generation cephalosporin antibiotic, debridement, dissection, and re-elevation of gastrocnemius muscle flap covering the exposed plate area in inferior, split skin graft above the muscle flap and VAC above skin graft with 75 mmHg pressure. Conclusion: Debridement with muscle flap and application of VAC in the deep infected wound of open reduction and internal fixation was found to be successful methods in minimizing complications and obtaining an optimal outcome. This finding was associated with accompanying morbidities or a good wound healing process.
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Panda, Sourav, Lorena Karanxha, Funda Goker, Anurag Satpathy, Silvio Taschieri, Luca Francetti, Abhaya Chandra Das, Manoj Kumar, Sital Panda, and Massimo Del Fabbro. "Autologous Platelet Concentrates in Treatment of Furcation Defects—A Systematic Review and Meta-Analysis." International Journal of Molecular Sciences 20, no. 6 (March 17, 2019): 1347. http://dx.doi.org/10.3390/ijms20061347.

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Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.
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Foo, Tun Lin, Ivan Tjun-Huat Chua, and Lester Wai-Mon Chan. "EXTENSIVE OPEN DRAINAGE FOR SUPPURATIVE FLEXOR TENOSYNOVITIS INVOLVING FIVE DIGITS: A CASE REPORT." Hand Surgery 17, no. 01 (January 2012): 111–13. http://dx.doi.org/10.1142/s0218810412720082.

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An unusual case of suppurative tenosynovitis involving all five digits up to distal forearm in a 20-year-old male with no known risk factors is reported. We highlight the strategy of extensile skin incisions from the wrist to all five digits that allowed flexor sheath debridement, synovectomy, and infection resolution without causing skin flap ischemia. At three months, total active motion of 70% of contralateral hand was achieved.
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Chen, Hsin-Han, and Pin-Keng Shih. "Fusarium infection–induced partial failure of free anterolateral thigh musculocutaneous flap: Case report." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1984196. http://dx.doi.org/10.1177/2050313x19841963.

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Fusarium species, a soil-borne fungi, causes disease in animals and humans, particularly in immunocompromized patients. A 62-year-old male presented with type II diabetes mellitus, diagnosed 4 years ago. He had a motorcycle accident-caused open tibiofibular fracture of the left lower extremity (Gustilo grade IIIb). With open reduction and internal fixation, an anterolateral thigh musculocutaneous flap was harvested for coverage of exposed bone and defect reconstruction. Partial failure of the flap occurred 9 days following reconstruction, and histological examination revealed Fusarium spp. After treatment with antifungal drugs and debridement, we performed a split-thickness skin graft. At 2-year follow-up, the flap was viable with adequate bone union. This is the first reported case of partial flap failure due to a Fusarium spp. infection. Possibility of fungal infections in patients with late-onset flap failure should be noted. Prompt diagnosis and treatment are needed to prevent repeated free-tissue transfer and/or devastating outcomes.
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Kim, Jinhyun, Taewoon Kim, and Seokchan Eun. "Reconstruction of Lower Extremity Necrotizing Fasciitis with Tibialis Anterior Musculofascial Flap and Skin Graft: A Case Report." Journal of Wound Management and Research 17, no. 3 (October 31, 2021): 222–26. http://dx.doi.org/10.22467/jwmr.2021.01697.

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Necrotizing fasciitis of the lower extremities results in large tissue defects, and most cases require reconstruction using skin grafts or flaps. We describe a 61-year-old man who developed necrotizing fasciitis of the right lower leg and septic shock, following a traumatic injury to his leg. Wound culture yielded methicillin-resistant Staphylococcus aureus. Extensive debridement was performed four times along with the use of appropriate antibiotics. After 2 weeks, physical examination showed an open wound (approximately 30×20 cm in size) with partial tibial bone exposure. Subsequently, the patient underwent successful reconstruction using a tibialis anterior musculofascial flap and split-thickness skin grafting. The tibialis anterior muscle was bihalved and pivoted to cover the exposed bone surface. The patient was without pain and was able to successfully perform daily activities at the 15-month follow-up. This case report highlights the utility of a bihalved tibialis anterior musculofascial flap for lower extremity reconstruction, particularly in patients for whom free flap transfers are unviable.
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Wilson Sallum, Antonio, Renato Vasconcelos Alves, Lucio Flavio Teixeira Damis, Patricia Fernanda Roesler Bertolini, Francisco Humberto Nociti, and Enilson Antonio Sallum. "Open flap debridement with or without intentional cementum removal: a 4-month follow-up." Journal of Clinical Periodontology 32, no. 9 (September 2005): 1007–10. http://dx.doi.org/10.1111/j.1600-051x.2005.00815.x.

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Pilloni, Andrea, Matteo Saccucci, Gabriele Di Carlo, Blerina Zeza, Marco Ambrosca, Michele Paolantonio, Gilberto Sammartino, Claudio Mongardini, and Antonella Polimeni. "Clinical Evaluation of the Regenerative Potential of EMD and NanoHA in Periodontal Infrabony Defects: A 2-Year Follow-Up." BioMed Research International 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/492725.

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Introduction.The aim of this retrospective study was to compare the clinical efficacy of four different surgical techniques in promoting periodontal regeneration in patients with infrabony defects: open flap debridement, application of enamel matrix derivatives (EMD), nanohydroxyapatite (nanoHA) application, and combined nanoHA and EMD application. Probing attachment level (PAL), pocket depth (PD), and position of gingival margin at completion of therapy (REC) were measured.Materials and Methods.Data were collected from 64 healthy patients (34 women and 30 men, mean age 37,7 years). Clinical indices were measured by a calibrated examiner at baseline and at 12, 18, and 24 months. The values obtained for each treatment were compared using nonparametric tests.Results.All treatments resulted in a tendency toward PD reduction over time, with improvements in REC and PAL. The differences in PD, REC, and PAL values at baseline compared with values after 12, 18, and 24 months were statistically significant for all treatments. Statistically significant differences in PAL and PD were detected between nanoHA and nanoHA + EMD at 12, 18, and 24 months.Conclusion.In this study, EMD and nanoHA used together in patients with infrabony periodontal lesions had better clinical efficacy than nanoHA alone, EMD alone, or open flap debridement.
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Jung, S. Heredero, G. Sánchez Aniceto, I. Zubillaga Rodríguez, R. Gutiérrez Diaz, and I. I. García Recuero. "Posttraumatic Frontal Bone Osteomyelitis." Craniomaxillofacial Trauma & Reconstruction 2, no. 2 (May 2009): 61–66. http://dx.doi.org/10.1055/s-0029-1202594.

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We present the clinical case of a patient with open bilateral frontal sinus fractures who developed a frontal osteomyelitis. A review of the problem and management ascending to the different alternatives for central anterior skull base defects and fronto-orbital reconstruction is also presented. After extensive radical debridement of the necrotic bone, final reconstruction of the skull base was performed by using a rectus abdominis free flap. A custom-made hard tissue replacement implant was used for the fronto-orbital reconstruction. Extensive debridement is required for the treatment of frontal osteomyelitis. An appropriate isolation of the skull base from the upper aerodigestive system must be obtained to prevent continuous infectious complications. Free flaps are especially useful for skull base reconstruction when traditional methods are not available or have failed because of the lack of available tissue for vascularized reconstruction. Custom-made alloplastic implants are a good reconstructive option for large fronto-orbital defects once the infection is gone and vascularized tissue has been transferred.
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Li, Runguang, Guozheng Zhu, Chaojie Chen, Yirong Chen, and Gaohong Ren. "Bone Transport for Treatment of Traumatic Composite Tibial Bone and Soft Tissue Defects: Any Specific Needs besides the Ilizarov Technique?" BioMed Research International 2020 (February 24, 2020): 1–13. http://dx.doi.org/10.1155/2020/2716547.

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Objective. To evaluate the surgical efficacy of bone transport (Ilizarov technique) plus “shortening-lengthening,” “flap surgery,” and “open bone transport” as individualized treatments for traumatic composite tibial bone and soft tissue defects. Methods. We retrospectively analyzed sixty-eight cases (mean age: 35.69 years, (range, 16–65)) treated from July 2014 to June 2017, including 29 middle, 18 distal, and 21 proximal tibial bone defects (4–18 cm, mean: 7.97 cm) with soft tissue defects (2.5 cm × 4.0 cm to 30.0 cm × 35.0 cm after debridement). We adopted the bone transport external fixator to fix the fracture after debriding the defect parts. In the meantime, we adopted the “shortening-lengthening technique,” “flap surgery,” and “open bone transport” as individualized treatment based on the location, range, and severity of the composite tibial bone and soft tissue defects. Postoperative follow-up was carried out. Surgical efficacy was assessed based on (1) wound healing; (2) bone defect healing rate; (3) external fixation time and index; (4) incidence/recurrence of deep infection; (5) postoperative complications; and (6) Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Results. The mean duration from injury to reconstruction was 22 days (4–80 d), and the mean postoperative follow-up period was 30.8 months (18–54 m). After the repair and reconstruction, 2 open bone transport patients required infected bone removal first before continuing the bone transport treatment. No deep infection (osteomyelitis) occurred or recurred in the remaining patients, and no secondary debridement was required. Some patients had complications after surgery. All the postoperative complications, including flap venous crisis, nail channel reaction, bone nonunion, mechanical axis deviation, and refracture, were improved or alleviated. External fixation time was 12.5 ± 3.41 months, and the index was 1.63 ± 0.44. According to the ASAMI score, 76.47% of the outcomes were good/excellent. Conclusion. The Ilizarov technique yields satisfactory efficacy for composite tibial bone and soft tissue defects when combined with “shortening-lengthening technique,” “flap surgery,” and “open bone transport” with appropriate individualized treatment strategies.
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Schaffer, Clara, Daniel Haselbach, Luigi Schiraldi, Karl Sörelius, Daniel F. Kalbermatten, Wassim Raffoul, and Pietro G. di Summa. "Abdominal-based adipocutaneous advancement flap for reconstructing inguinal defects with contraindications to standard reconstructive approaches: a simple and safe salvage reconstructive option." Archives of Plastic Surgery 48, no. 4 (July 15, 2021): 395–403. http://dx.doi.org/10.5999/aps.2019.01795.

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Background Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity.Methods This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed.Results Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years.Conclusions Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.
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Nayyar, AbhishekSingh, MotilalR Jangid, PS Rakhewar, and AnupR Cholepatil. "Comparative evaluation of fisiograft (polylactic and polyglycolic acid co-polymer) with open flap debridement (OFD) versus open flap debridement (OFD) alone in the treatment of periodontal intra-bony defects: A clinical and radiographic study." Journal of Clinical Sciences 14, no. 1 (2017): 42. http://dx.doi.org/10.4103/2468-6859.199171.

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Altmann, S., H. Fansa, and W. Schneider. "Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment." Journal of Cutaneous Medicine and Surgery 8, no. 1 (January 2004): 6–10. http://dx.doi.org/10.1177/120347540400800102.

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Background:Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice.Methods:We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks.Results:No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients.Conclusions:Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.
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Nayyar, AbhishekSingh, Khushboo Deshmukh, Devanand Shetty, Arvind Shetty, and Ruparani Bodduru. "Comparative evaluation of the efficacy of closed pocket debridement with diode laser and periodontal open flap debridement: A clinical and microbiologic study." Journal of Clinical Sciences 15, no. 3 (2018): 113. http://dx.doi.org/10.4103/jcls.jcls_72_16.

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Reade, Clifton C., William M. Meadows, Curtis E. Bower, Janice F. Lalikos, Richard S. Zeri, and William A. Wooden. "Laparoscopic Omental Harvest for Flap Coverage in Complex Mediastinitis." American Surgeon 69, no. 12 (December 2003): 1072–76. http://dx.doi.org/10.1177/000313480306901210.

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Mediastinitis is one of the most serious complications of cardiac surgery. The standard of care in mediastinitis includes thorough sequential debridement, flap coverage, and culture-directed antibiotics. The most frequently utilized muscles for flap reconstruction include the rectus abdomi-nus and the pectoralis major. However, in some instances these flaps may be inadequate, unavailable, or fail, thus requiring an alternative choice or adjuvant. Most coronary graft procedures utilize the left internal mammary artery, frequently eliminating the left rectus muscles, while prior open cholecystectomy patients frequently lose availability of their right rectus muscle. In addition, radiation therapy or prior flap failure may exclude other muscle transfer procedures. The omentum offers excellent coverage due to mobility and superb arterial and lymphatic flow. Unfortunately, in the past, this has required a celiotomy in an already critically ill patient. We present a series of 5 patients where the omentum was mobilized laparoscopically and passed through an anterior diaphragmatic incision. This option spares a celiotomy, seals the wound, and hastens recovery in very ill patients. We also present a complete review of literature on the topic and provide an algorithm for complex sternal wound reconstruction.
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Hallström, Hadar, G. Rutger Persson, Susann Lindgren, and Stefan Renvert. "Open flap debridement of peri-implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial." Journal of Clinical Periodontology 44, no. 12 (December 2017): 1285–93. http://dx.doi.org/10.1111/jcpe.12805.

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Alvarado Iñiguez, Xavier Israel, David Alejandro Torres Jáuregui, and Fulvio Enrique Zúñiga Cabrera. "Caso Clínico: Fractura expuesta grave del dedo índice. Cirugía de rescate con colgajo adipofascial vascularizado homodigital reverso." Revista Médica del Hospital José Carrasco Arteaga 12, no. 2 (July 31, 2020): 125–29. http://dx.doi.org/10.14410/2020.12.2.cc.18.

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BACKGROUND: Hand trauma has a high incidence worldwide, it accounts nearly 30% of all trauma and medical visits to emergency rooms, fingertip injuries are the most common among hand trauma. The initial management and the proper choice of treatment are important, the main objective is to achieve adequate tissue coverage, in order to avoid unnecessary amputation, prevent complications and functionality loss. CASE REPORT: A 32-year-old male patient presented with crush trauma on right hand resulting in injuries with tissue loss on the fingertips of the second and third finger and traumatic partial amputation of the distal phalanx of the second finger. EVOLUTION: Surgical technique of homodigital vascularized adipofascial reverse flap was performed in second finger and the fracture was managed conservatively, without complications. A weekly follow up was carried out for 2 months with favorable functional, biological and aesthetic results. The third finger was treated with surgical irrigation and debridement and placement of a sub-occlusive bandage, with favorable outcome. CONCLUSION: Homodigital adipofascial reverse dorsal flap has advantages over other types of conventional flaps; it is a simpler, safe and reliable technique, with good postsurgical outcomes in terms of functionality, aesthetics and recovery, needing only one intervention and offering the appropriate coverage to exposed bone and soft tissue, with minimal repercussions on the donor site.
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Thapa, Sujan, Vanita Gautam, Snigdha Shubham, Manisha Nepal, and Kriti Shrestha. "Stumbling upon Palatogingival Groove: A Case Report." Journal of Universal College of Medical Sciences 9, no. 02 (December 31, 2021): 94–96. http://dx.doi.org/10.3126/jucms.v9i02.42023.

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Palatogingival grooves (PGG) are developmental malformations infamous for precipitating endodontic-periodontal lesions. Pertaining to their discreet occurrence, variation in groove depth and funnel like shape, adherence of plaque and calculus is apparent thereby jeopardizing the periodontium and pulp. A case of palatogingival groove in maxillary left lateral incisor was diagnosed and managed with endodontic treatment followed by open flap debridement to seal the groove with biodentine and fill the defect with bone graft. On follow up, the periapical lesion and the periodontal pocket were successfully resolved.
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Pradhan, Shaili, Regina Shrestha, and Ranjita Shrestha Gorkhali. "Pain Perception after Periodontal Therapies." Journal of Nepalese Society of Periodontology and Oral Implantology 2, no. 2 (December 31, 2018): 56–60. http://dx.doi.org/10.3126/jnspoi.v2i2.23615.

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Background: Pain perception is a complex sensory experience which is perceived by different individuals in different manners. The pain perceived by the patient after periodontal surgery may vary based on different parameters. Aim: This observational study was conducted to evaluate the perception of pain after periodontal therapies. Materials and Methods: A total of 63 surgeries were carried out in 50 patients and the surgeries were divided into three categories: open flap debridement, resective and regenerative surgeries, and periodontal plastic surgeries. The pain experienced by the patient was recorded on the visual analog scale that ranged from 0 to 10. Results: The mean VAS score for different periodontal surgeries was 2.49. The study showed highest mean VAS in open flap debridement (2.74) followed by periodontal plastic surgery (2.5) and the lowest in resective and regenerative procedures (2.13). Among various variables such as age, sex, periodontal dressing, arch, amount of local anaesthesia and time duration, the data showed statistical difference between VAS score and sex (p = 0.04) and between VAS score and amount of local anaesthesia (p = 0.012). Conclusion: The study showed there is low pain perception after different periodontal surgeries as measured by VAS. Proper understanding of the variables that affect pain is important as they may produce emotional responses that could influence compliance and the therapy result. Inadvertent use of large dose of anaesthetics beforehand assuming high anticipation of pain should be discouraged as the increase in volume relates to increased pain.
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Sharma, Shreebindu, Bandana Koirala, Mamta Dali, and Sneha Shrestha. "Modified Band and Loop Appliance for Retention of Periodontal Dressing on Denuded Bone: A Case Report." Journal of Nepalese Association of Pediatric Dentistry 3, no. 1 (December 12, 2022): 36–39. http://dx.doi.org/10.3126/jnapd.v3i1.50063.

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Intraoral lacerations without gape heal spontaneously, whereas lacerations gaping open need to be managed with primary closure or advancement flap. Fall injury leading to a laceration over the left maxillary vestibular region extending till the alveolar ridge with avulsed tooth where primary closure was not possible was planned for debridement followed by periodontal dressing. Due to the lack of retentive area, modified band and loop appliance with a T-loop was fabricated and used for the retention of periodontal dressing for the healing of denuded bone following trauma.
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Papa, Giovanni, Vittorio Ramella, Federico Novati, Uros Ahcan, Chiara Stocco, and Zoran Arnež. "Limb and Flap Salvage in Gustilo IIIC Injuries Treated by Vascular Repair and Emergency Free Flap Transfer." Journal of Reconstructive Microsurgery 33, S 01 (October 2017): S03—S07. http://dx.doi.org/10.1055/s-0037-1603737.

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Background Gustilo classification system defines IIIC fractures as open fractures associated with an arterial injury that requires repair. The aim of our study was to analyze the early outcome in terms of limb and flap salvage, early amputation, and early complication rate in patients with Gustilo IIIC open fractures treated in an emergency setup. Methods We retrospectively reviewed 20 patients with Gustilo IIIC injuries treated by the “fix and flap” principle during the first surgical procedure in the first 24 hours after injury (emergency free flap transfer). All patients underwent surgery with radical debridement, wound irrigation, skeletal stabilization, vascular repair, and immediate free flap coverage. Results In this study, 18 patients were men (90%) and 2 were women (10%). In all patients, a vascular repair was performed and in 17 cases (85%), the lower limb/foot was avascular and limb salvage was performed. Three patients had one vessels injured (15%) and 17 had two or three vessels injured (85%). In 9 out of 20 (45%), a revision surgery was needed for arterial (10%, 2 patients), arterial–venous (15%, 3 patients), and venous thrombosis (20%, 4 patients), while 4 patients required an early amputation (20%) and 1, a late one (5%). In three patients (15%), a flap loss occurred. Superficial infection occurred in seven cases (35%) and deep infection (osteomyelitis) in one (5%). Conclusion A single-stage procedure performed in an emergency operating room could lead to an effective outcome with a high rate of limb salvage and satisfying long-term results.
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Banjanovic, Bedrudin, Ilirijana Karabi, Slavenka Straus, Nermir Granov, Emir Kabil, Malik Jakirlic, Ilijaz Pilav, and Muhamed Djedovic. "Our Experiences in the Treatment of Anterior Chest Wall Infections (2015 - 2021)." Materia Socio Medica 34, no. 2 (2022): 142. http://dx.doi.org/10.5455/msm.2022.34.142-148.

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Background: Sternotomy is a classical surgical procedure for approaching the heart and mediastinum. Sternotomy wound infections can be superficial or deep. Objective: The aim of this study is to retrospectively evaluate the results of two treatments for deep sternal wound infection (DSWI), closed treatment (debridement, refixation and retrosternal irrigation) and open treatment (debridement, VAC therapy and then pectoral flap). Methods: Retrospective analysis of two methods of treatment of DSWI in the period of six years. The first group (G1): surgical debridement, sternum fixation with, if necessary, retrosternal irrigation. The second group (G2): surgical debridement, open sternum with VAC therapy and subsequent pectoral flap with sternum refixation if necessary. Sternotomy wound infection will be classified according to the depth of the affected areas and the time of infection. Risk factors, outcome, local findings, number of revisions, number of hospital treatment days, types of isolates, etiology of sternotomy, time from onset of sternal instability to first surgical treatment will be observed.: Results: The number of patients with DSWI was 16, which represents 1% of all sternotomy in the observed period. Mortality in the DSWI group was 35%. Surgical myocardial revascularization was initially performed in 73% of patients with DSWI. Two risk factors for DSWI were in 32% of patients and 25% had diabetes mellitus. The average time for DSWI development in G1 was 10 days (min 0, max 30) and in G2 was 20 days (min 12, max 30). Number of revisions in G1 (min 1, max 2), G2 (min 1, max 3). Average number of hospital days were in G1 23.50 days (SD 13.15), and in G2 38.17 days (SD 28.65). The sternum was osteomyelitic and fragmented in 20% of patients. More than one revision occurred in 40% of patients. The main initial isolate was Enterococcus faecalis in 27% of all DSWI (dominantly in G1 2/3 of all).: Conclusion: We found that there is no statistically significant difference in observed treatments, and that each treatment has its own indications. We suggested that studies with a larger sample are needed for a definite opinion on this issue.
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Lopez, Rodrigo, and Vibeke Baelum. "Is grafting biomaterials or biological agents more effective than open-flap debridement in treating deep intraosseous defects?" Evidence-Based Dentistry 4, no. 3 (September 2003): 64–65. http://dx.doi.org/10.1038/sj.ebd.6400195.

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Rahadianti, Tissa, Dahlia Herawati, and Kwartarini Murdiastuti. "Effect of advanced-platelet rich-fibrin combined with rosuvastatin application after open flap debridement of infrabony pocket." Majalah Kedokteran Gigi Indonesia 7, no. 2 (June 7, 2022): 110. http://dx.doi.org/10.22146/majkedgiind.53419.

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Open flap debridement (OFD) is an invasive therapy for chronic periodontitis with pocket 5 mm or more. However, it is difficult to achieve regeneration and new attachment with this therapy. Periodontitis starts to add growth factors and local drugs delivery as host modulation therapy. Advanced-PRF (A-PRF) contains more growth factor than PRF which plays a role in promoting fibroblast proliferation, reepithelization, extracellular matrix production, and endothelial cell migration. 1.2% rosuvastatin gel (RSV) is a local delivery drug with a pleiotropic effect that can modify host response to promoting BMSCs, BMP-2, OPG, ALP, RANKL, and osteoblasts. This study aimed to examine the effect of the application of A-PRF+RSV in OFD therapy of which the parameters were probing depth (PD), relative attachment loss (RAL), and alveolar bone height. The study samples consisted of 24 periodontal pockets which were divided into 2 groups of 12 pockets each, namely A-PRF+RSV for group 1 and PRF+RSV for group 2. Clinical evaluations were carried out on baseline, day-30, and day-90 for PD and RAL, and on baseline and day -90 for alveolar bone height. Data of PD and RAL reduction were analyzed with non-parametric test Mann-Withney, while data of reduction of alveolar bone height were analyzed with parametric Independent-T test. Group 1 obtained a statistically more significant result in reducing PD, RAL, and alveolar bone height compared to group 2 (p<0.05) To conclude, the application of A-PRF and 1.2% rosuvastatin gel in OFD procedure promotes a higher PD and RAL reduction and alveolar bone height increase than the application of PRF coupled with 1.2% rosuvastatin gel.
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Kynta, Reuben Lamiaki, Neelamjingbha Sun, and Manuj Kumar Saikia. "Muscle flaps in pulmonary infections: a case series from Northeast India." Asian Cardiovascular and Thoracic Annals 28, no. 8 (August 6, 2020): 488–94. http://dx.doi.org/10.1177/0218492320949074.

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Aim Treatment of complications due to pulmonary infections usually involves lung resection with or without debridement. Managing residual intrathoracic defects, chronic empyema, and bronchopleural fistulae after such resections poses unique challenges. Methods We retrospectively reviewed the data of all 9 patients referred to us with complications due to pulmonary infections, including the surgical procedures, flaps used, and their outcomes between 2018 and 2019. Results The mean age of the patients was 30 years (range 9?48 years). The primary disease was tuberculosis in 6 (66%) patients. Complications of primary infections were pneumothorax ( n = 3), auto-pneumonectomy ( n = 2), organized empyema ( n = 3), and recurrent hemoptysis ( n = 1). Initial interventions included lobectomy ( n = 2), tracheoesophageal repair ( n = 1), bronchial artery embolization ( n = 1), intercostal tube drainage ( n = 4), and decortication( n = 1). Complications after primary interventions included bronchopleural fistula ( n = 4, 45%), recurrent empyema ( n = 3, 33%), tracheal stump dehiscence ( n = 1, 11%) and non-resolving hemoptysis ( n = 1, 11%). Pathological microorganisms were isolated in 8 (88%) patients. Secondary corrective surgical interventions along with pedicled muscle flap interposition and reinforcement were undertaken. Nine flap procedures with or without thoracoplasty were performed. There was no open thoracostomy conversion. There was one death postoperatively. Conclusion A locoregional pedicled flap with or without thoracoplasty is an effective option to manage complications of pulmonary infections. The cardiothoracic surgeon should have a knowledge of the locoregional flaps of the thorax and abdomen to address such complications.
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Gaber, Dalia Shawky, Nevine Hassan Kheir El Din, Hamdy Ahmed Nassar, Mostafa Saad El-Din Ashmawy, and Ola Mohamed Ezzatt. "Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study." Perio J 5, no. 1 (December 31, 2021): 28–37. http://dx.doi.org/10.26810/perioj.2021.a4.

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Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.
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Farías-Cisneros, Efraín, Jorge Luis Martínez-Peniche, Luis Carlos Olguín-Delgado, Francisco Guillermo Castillo-Vázquez, Ranulfo Romo-Rodríguez, and Armando Torres-Gómez. "Total Elbow Arthroplasty and Antegrade Posterior Interosseous Flap for Infected Posttraumatic Arthritis with an Active Fistula. A Rationale for Comprehensive Treatment. Case Report." Journal of Shoulder and Elbow Arthroplasty 6 (January 2022): 247154922210907. http://dx.doi.org/10.1177/24715492221090745.

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Abstract:
The indication for total elbow arthroplasty (TEA) for primary and posttraumatic elbow arthritis has increased, however, its indication after infection remains elusive. Wound closure about the elbow increases the challenge of treating a previously infected elbow, often necessitating soft tissue coverage with local or regional flaps. We present a 75-year-old male patient with an elbow infection following a failed complex intraarticular fracture open reduction and internal fixation of the distal humerus. Initially, he presented with severe functional impairment and pain, also with an active fistula with serous exudate, whose culture was positive for Cutinebacterium acnes. Septic hardware loosening, and septic nonunion with intraarticular involvement of the left elbow was diagnosed. The patient underwent hardware removal, fistulectomy, serial irrigation and debridement and a pedicled antegrade posterior interosseous artery (PIA) flap on staged surgical treatment. Finally, after ruling out infection persistence, a TEA was performed. We aim to report the outcome of a patient treated with a TEA in the context of a previously infected elbow with soft tissue coverage with an antegrade PIA flap. Comprehensive treatment must be done in an appropriate manner, to obtain an expedited and desirable outcome.
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50

Niinimäki, Tuukka, Susanna Yli-Luukko, Hannu Syrjälä, Outi Kaarela, and Juhana Leppilahti. "Deep Infection in the Sinus Tarsi after Triple Arthrodesis in Rheumatoid Patients: A Case Report." Foot & Ankle International 29, no. 11 (November 2008): 1131–35. http://dx.doi.org/10.3113/fai.2008.1131.

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Abstract:
Background: Triple arthrodesis can be used to correct hind-foot deformities in rheumatoid patients. Postoperative deep infections after triple arthrodesis are challenging to treat often requiring both operative debridement and antimicrobial therapy. The purpose of the present study was to review the treatment of deep infections in the sinus tarsi region in rheumatoid patients after triple arthrodesis using antimicrobial therapy and Papineau bone grafting or local muscle flap. Materials and Methods: Seven rheumatoid patients out of 97 who underwent triple arthrodesis between January 1997 and June 2006 had a deep postoperative infection in the sinus tarsi region. These infections were treated with systemic antibiotic therapy combined with open cancellous bone grafting (Papineau technique) in four cases and with a local muscle flap (adductor digiti minimi) in three cases. Results: The median time from diagnosis of the deep infection to complete healing in six patients averaged 22 weeks, while one patient developed sepsis and died one year later. The most common pathogens were staphylococcus epidermis and staphylococcus aureus; a total of 15 pathogens were found. The average number of revision operations before the infection was considered to have resolved completely was seven. Conclusion: The rate of deep infections was 7.2% among rheumatoid patients. Infections are challenging to treat and cause prolonged morbidity. Surgical debridement and systemic antibiotic therapy combined with Papineau grafting or a local muscle flap usually yielded successful results after postoperative deep infection of the sinus tarsi region in rheumatoid patients. Level of Evidence: IV, Retrospective Case Series
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