Faculty Bibliography

With technological advances in magnetic resonance angiography (MRA), spatial resolution of 1-mm perforating vessels can reliably be visualized and accurately located in reference to patients' anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast, resulting in optimal perforator selection, improved flap design, and increased surgical efficiency. As their experience with MRA in breast reconstruction has increased, the authors have made changes to their MRA protocol that allow imaging of the vasculature in multiple donor sites (buttock, abdomen, and upper thigh) in one study. This article provides details of this experience with multiple donor site contrast-enhanced MRA.

Biologic prostheses have emerged to address the limitations of synthetic materials for ventral hernia repairs; however, they lack experimental comparative data. Fifteen swine were randomly assigned to 1 of 3 bioprosthetic groups (DermaMatrix, AlloDerm, and Permacol) after creation of a full thickness ventral fascial defect. At 15 weeks, host incorporation, hernia recurrence, adhesion formation, neovascularization, inflammation, and biomechanical properties were assessed. No animals had hernia recurrence or eventration. DermaMatrix and Alloderm implants demonstrated more adhesions, greater inflammatory infiltration, and more longitudinal laxity, but near identical neovascularization and tensile strength to Permacol. We found that porcine acellular dermal products (Permacol) contain following essential properties of an ideal ventral hernia repair material: low inflammation, less elastin and stretch, lower adhesion rates and cost, and more contracture. The addition of lower cost xenogeneic acellular dermal products to the repertoire of available acellular dermal products demonstrates promise, but requires long-term clinical studies to verify advantages and efficacy.

Avatar carries a pejorative connotation often related to an unfortunate hazard. In face transplants, incarnations were numerous. The analysis of their evolution through time and increasing sophistication of procedures turn out to be informative regarding the wide disrepairs in the craniofacial area. The authors report the principal constraints of face transplant and the evolution in minds to deal with it

BACKGROUND: The authors analyzed the in vitro and in vivo performance of lithium disilicate glass-ceramic (LDGC) restorations and yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) (that is, zirconium oxide) restorations with regard to reliability, clinical performance and abrasion resistance. METHODS: In the in vitro study, four authors subjected samples of LDGC, Y-TZP and metal-ceramic crowns to step-stress fatigue testing. Four investigators assessed the in vivo clinical performance of LDGC and zirconium oxide-based restorations at four and seven years, respectively. In addition, one author conducted a randomized, controlled clinical trial to analyze the volumetric loss of enamel and ceramic antagonist surfaces. RESULTS: The LDGC crowns exhibited the highest fatigue load-to-failure values in the in vitro analysis. The results of the in vivo assessment showed that the clinical performance of the LDGC restorations at four years was comparable to that of the zirconium oxide-based crowns at seven years. The results of the in vivo, randomized, controlled clinical trial showed that LDGC crowns were not only resistant to wear, but also were wear friendly to enamel antagonist surfaces. CONCLUSIONS: The LDGC crowns in the in vitro and in vivo studies exhibited high durability, and they were wear friendly to opposing natural dentition. CLINICAL IMPLICATIONS: LDGC and zirconium oxide-based crowns are a clinically acceptable means of treating teeth that require full-coverage restorations. In addition, LDGC materials exhibit excellent clinical performance, as well as demonstrate acceptable abrasion compatibility with the opposing natural dentition

Several all-ceramic systems have been developed in dentistry to meet the increased expectations of patients and dentists for highly aesthetic, biocompatible, and long-lasting restorations. However, early bulk fractures or chippings have led the research community to investigate the mechanical performance of the all-ceramic systems. This overview explores the current knowledge of monolithic and bilayer dental all-ceramic systems, addressing composition and processing mechanisms, laboratory and clinical performance, and possible future trends for all-ceramic materials

BACKGROUND: : Patients with bilateral cleft lip-cleft palate have nasal deformities including reduced nasal tip projection, widened ala base, and a deficient or absent columella. The authors compare the nasal morphology of patients treated with presurgical nasoalveolar molding followed by primary lip/nasal reconstruction with age-matched noncleft controls. METHODS: : A longitudinal, retrospective review of 77 nonsyndromic patients with bilateral cleft lip-cleft palate was performed. Nasal tip protrusion, alar base width, alar width, columella length, and columella width were measured at five time points spanning 12.5 years. A one-sample t test was used for statistical comparison to an age-matched noncleft population published by Farkas. RESULTS: : All five measurements demonstrated parallel, proportional growth in the treatment group relative to the noncleft group. The nasal tip protrusion, alar base width, alar width, columella length, and columella width were not statistically different from those of the noncleft, age-matched control group at age 12.5 years. The nasal tip protrusion also showed no difference in length at 7 and 12.5 years. The alar width and alar base width were significantly wider at the first four time points. CONCLUSIONS: : This is the first study to describe nasal morphology following nasoalveolar molding and primary surgical repair in patients with bilateral cleft lip-cleft palate through the age of 12.5 years. In this investigation, the authors have shown that patients with bilateral cleft lip-cleft palate treated at their institution with nasoalveolar molding and primary nasal reconstruction, performed at the time of their lip repair, attained nearly normal nasal morphology through 12.5 years of age

HYPOTHESIS: Damage control laparotomy (DCL) has beneficial effects on the long-term morbidity and survival of trauma patients. DESIGN: Prospective study. SETTING: Level I trauma center. PATIENTS: Eighty-eight trauma patients who were admitted during a 3-year period (January 1, 2000, through December 31, 2003) underwent damage control laparotomy and were subsequently followed up (January 1, 2001, through December 31, 2008). INTERVENTION: Damage control laparotomy. MAIN OUTCOME MEASURES: Major and long-term complications, lengths of stay, mortality, readmissions, subsequent surgical procedures, activities of daily living, and return to work. RESULTS: On admission, the mean age and Injury Severity Score were 33 years and 34, respectively. Of the 88 patients, 66 (75%) were male; 46 patients had blunt injuries and 42 had penetrating injuries. Liver was the most common injury (63 patients), followed by bowel (34), spleen (33), major vessel (19), and pancreas (10). The mean admission pH and temperature were 7.19 and 34.4 degrees C, respectively, with 21.5 U of packed red blood cells transfused. The mean (SD) number of initial abdominal operations was 4.6 (2.5) per patient, with an overall mortality of 28% (25 patients). Intensive care unit and hospital lengths of stay were 18 (15) and 32 (20) days, respectively. Of the 63 patients who survived, 58 underwent intra-abdominal closure with polyglactin mesh. During the study, 44 intra-abdominal infections and 18 enterocutaneous fistulas were diagnosed. All 63 survivors were readmitted at least once. There were a total of 186 readmissions and 92 subsequent surgical procedures. Ventral hernia repair (66 readmissions) was the most common reason for readmission, followed by infection (41) and fistula management (29). There was 0% mortality for patients who survived the preliminary hospitalization. Of the 63 surviving patients, 51 (81%) reported that they had gone back to work and resumed normal daily activities. CONCLUSION: Although damage control laparotomy is associated with a significant complication and readmission rate, its overall benefit is indisputable.