Reconstruction of Orbital Exenteration Defects by Primary Closure Using Cheek Advancement.
Reconstruction of orbital exenteration defects by primary closure using cheek advancement.
Filed under: Rehab Centers
Br J Ophthalmol. 2012 Dec 4;
Sira M, Malhotra R
INTRODUCTION: Orbital exenteration is a highly disfiguring procedure which, although providing local control of invasive orbital malignancy also results in marked visual, psychological and social disability. We present three consecutive total exenteration cases over 1 year where all 3, including extended exenteration defects, were repaired by primary closure by way of cheek advancement. This technique may be considered where succinct management with minimal follow-up is required and maybe preferable if considering rapidity of rehabilitation with a short time to fitting definitive prostheses. METHODS: Retrospective review of three consecutive patients who presented with neglected basal cell carcinoma with orbital invasion and subsequently underwent total orbital exenteration with repair by cheek advancement flap. RESULTS: All underwent repair with primary skin closure using a cheek advancement flap. Patient 2 developed a small area of central flap dehiscence noted at 2 months with almost complete granulation of the orbital cavity at 3 months. Patients 1, 2 and 3 were fitted with final prosthesis at 7, 6 and 12 months, respectively. CONCLUSIONS: Reconstruction of the exenterated orbit using cheek advancement represents an evolution of the cervico-facial flap repair. The cheek advancement avoids creating a secondary defect and because it involves less dissection and additional skin incisions, is an easier procedure to perform with fewer facial scars. It does not preclude osseointegration if required at a later date and as such we recommend it as an option in repairing the exenterated orbit.
HubMed – rehab
One-stage bilateral anterior cruciate ligament reconstruction.
Filed under: Rehab Centers
Knee Surg Sports Traumatol Arthrosc. 2012 Dec 5;
Sajovic M, Demsar S, Sajovic R
PURPOSE: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL) deficiency remains controversial. The purpose was to evaluate cost and functional results after one-stage bilateral ACL reconstruction using either hamstring or patella tendon autograft. METHODS: This prospective comparative study was compared the mid-term outcome of 7 patients (14 knees) who had one-stage bilateral ACL reconstruction with that of a matched group of patients who had unilateral reconstruction (21 patients). RESULTS: The median length of hospital stay was 4 (3-5) nights for the bilateral group and 2 (1-4) nights for the control group. The duration of rehabilitation process in patients from control group with unilateral ACL reconstruction was one week shorter (9 vs 8 weeks). In the bilateral group, the median Lysholm score was 96 (85-100), and in the control group, the median score was 93 (81-100). The median time to return to full-time work and to full sports was 9 weeks and 7 months for the one-stage group and 8 weeks and 6 months for the unilateral group. Six patients (86 %) in the bilateral group and 17 patients (81 %) in the control group were still performing at their pre-injury level of activity. National Health Institution saved 2925 EUR when we performed one-stage bilateral reconstruction instead of two-stage ACL reconstruction. CONCLUSIONS: Mid-term clinical results suggested that one-stage bilateral ACL reconstruction using either hamstring or patella tendon autograft is clinically effective. For patients presenting bilateral ACL-deficient knees, one-stage bilateral ACL reconstruction is reproducible, cost effective and does not compromise functional results. LEVEL OF EVIDENCE: II.
HubMed – rehab
Cadaveric assessment of osteoarthritic changes in the patello-femoral joint: evaluation of 203 knees.
Filed under: Rehab Centers
Knee Surg Sports Traumatol Arthrosc. 2012 Dec 2;
Iriuchishima T, Ryu K, Aizawa S, Yorifuji H
PURPOSE: The purpose of this study was to determine the prevalence, type of lesion, and depth of osteoarthritic (OA) changes in the patello-femoral (PF) joint. METHODS: Two hundred and three cadaveric knees were included in this study with median age of 84 years (54-97). Patella OA lesions were classified using Han’s method: (Type 1) no or minimal lesion, (Type 2) medial facet lesion without involvement of the ridge, (Type 3) lateral facet lesion without involvement of the ridge, (Type 4) lesion involvement of the ridge, (Type 5) medial facet lesion with involvement of the ridge, (Type 6) lateral facet lesion with involvement of the ridge, (Type 7) global lesion. Femoral side OA lesions in the PF joint were classified using modified Chang’s method: (Type 1) no or minimal lesion, (Type 2) medial facet lesion, (Type 3) centre of patella groove lesion, (Type 4) lateral facet lesion, (Type 5) global lesion. OA depth evaluation was performed following Outerbridge’s classification. RESULTS: OA lesions of the patella were observed as follows: (Type 1) 31 %, (Type 2) 16 %, (Type 3) 3 %, (Type 4) 12 %, (Type 5) 22 %, (Type 6) 2 %, (Type 7) 14 %. Outerbridge’s classification of over Grade 2 OA depth was observed in 75.9 % of subjects. Femoral side OA lesions of the PF joint were observed as follows: (Type 1) 42 %, (Type 2) 20 %, (Type 3) 26 %, (Type 4) 2 %, (Type 5) 11 %. Outerbridge’s classification of over Grade 2 OA depth was observed in 58 % of subjects. CONCLUSION: Patella OA and femoral side OA in the PF joint occurred mainly on the medial side. Isolated OA in the lateral facet of the PF joint was exceedingly rare. Female subjects had a greater incidence of severe PF-OA than male subjects, and therefore, the physicians should pay attention when they treat the female subjects not to advance the PF-OA.
HubMed – rehab
More Rehab Centers Information…