Repair of a Complicated Calvarial Defect: Reconstruction of an Infected Wound With rhBMP-2.

Background: Management of the previously infected craniofacial defect remains a significant clinical challenge, posing obstacles such as wound healing complications, lack of donor site availability, and predisposition to failure of the repair. Optimal therapy would reconstruct like with like, without donor site morbidity. The purpose of this study was to compare the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)-mediated bone regeneration with the current standard of autologous bone graft for repair of previously infected calvarial defects.

The clinical anatomy of the inferior vena cava: a review of common congenital anomalies and considerations for clinicians.

Anomalies in the course and drainage of the Inferior Vena Cava (IVC) may complicate normal functioning, correct diagnosis, and therapeutic interventions within the abdomen. Development of the IVC occurs during the 4th to 8th week of gestation, and due to its developmental complexity, there are many opportunities for malformations to occur. Although most IVC anomalies are clinically silent and are usually discovered incidentally on abdominal imaging, aberrations may be responsible for formation of thrombosis, back pain, and anomalous circulation of blood to the heart.

Intraoperative high-dose epinephrine infiltration in cleft palate repair.

Objective: Local infiltration of epinephrine before surgical procedures is a well-accepted technique to promote vasoconstriction. Typically, the dose of epinephrine is limited by the co-administration of local anesthetic as well as the risk for arrhythmogenesis and hemodynamic changes. In addition, some controversy exists regarding the acceptable dose of epinephrine given to children.

The lateral thoracic artery revisited.

Background: Although the variations in the origin of the branches of the axillary and subclavian arteries have been well documented, little information regarding the highly variable lateral thoracic artery (LTA) is available. Descriptions of the LTA variations may prove useful during procedures of the lateral aspects of the thorax such as reconstructive plastic surgery and modified radical mastectomy.

Purpose: The aim of this study was to examine the anatomy of the LTA and offer an accurate account of its variability.

BMP-2-regenerated calvarial bone: a biomechanical appraisal in a large animal model.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is gaining popularity in craniofacial applications. Calvarial defects are, under normal circumstances, subjected to only minimal levels of the biomechanical stresses known to play an important role in osteogenesis, yet regenerated calvarial bone must be capable of withstanding traumatic forces such that the underlying neurocapsule is protected. The aim of this study is to, for the first time, assess the biomechanical properties of calvarial bone regenerated with derivations of a commercially available rhBMP-2-based system.

Novel animal model of calvarial defect: part IV. Reconstruction of a calvarial wound complicated by durectomy.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to be an effective therapy in the acute calvarial defect wound and in calvarial defects complicated by chronic scar and radiation. The authors assessed the effectiveness of rhBMP-2-mediated bone regeneration in calvarial defects complicated by durectomy.

Methods: Sixteen adult New Zealand White rabbits underwent subtotal calvariectomy and dural removal, followed by dural repair and reconstruction in one of four groups: empty (n = 3), vehicle (buffer solution on an absorbable collagen sponge, n = 2), autologous graft (n = 3), or rhBMP-2 repair (rhBMP-2/absorbable collagen sponge, n = 8).

Novel animal model of calvarial defect: part III. Reconstruction of an irradiated wound with rhBMP-2.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to be an effective therapy in the acute calvarial defect wound and in calvarial defects complicated by chronic scar. The authors compared the effectiveness of rhBMP-2 with the accepted standard of autologous graft for repair of irradiated calvarial defects.

Methods: Nineteen adult New Zealand White rabbits underwent subtotal calvariectomy.

Novel model of calvarial defect in an infected unfavorable wound: reconstruction with rhBMP-2. Part II.

Background: Animal models of bone reconstruction have shown recombinant human bone morphogenetic protein 2 (rhBMP-2) to be an effective therapy in the acute calvarial defect wound. The purpose of this study was to compare the effectiveness of rhBMP-2 in a rabbit model of an unfavorable scarred calvarial wound with the criterion standard of autograft.

Methods: Nineteen adult New Zealand white rabbits underwent subtotal calvariectomy.

Custom porous polyethylene implants for large-scale pediatric skull reconstruction: early outcomes.

Background And Purpose: Some of the most problematic craniofacial injuries in pediatric plastic surgery are large calvarial defects in children who have passed the age of maximal dural osteogenic potential and yet are too young to yield split calvarial grafts. Porous polyethylene (Medpor; Porex) is an alloplastic material that can be customized to precisely match a cranial defect. We present a clinical series that demonstrates successful use of porous polyethylene cranioplasties in large pediatric cranial defects.

The psychological burden of idiopathic adolescent gynecomastia.

Background: For a population of adolescents, gynecomastia is a persistent problem. Occurring during a critical period in the formation of self-image and gender identity, this gender-incongruent process may disrupt normal psychological development. This study was designed to identify the prevalence of psychological disturbances in young male patients presenting with symptomatic gynecomastia to determine whether psychological examination should be included as a routine portion of this patient population's treatment.

Pediatric facial fractures: demographics, injury patterns, and associated injuries in 772 consecutive patients.

Background: Pediatric craniofacial fractures are anatomically distinct from their adult counterparts and must be managed with respect for future growth and development. These injuries must be approached as entities fundamentally different from adult craniofacial fractures. Here, the authors aim to provide context for practitioners managing pediatric facial fractures by augmenting presently available demographic, diagnostic, and treatment data.

Antibiotic duration and postoperative infection rates in mandibular fractures.

Background: Although the use of preoperative antibiotics has been proven effective, the value of postoperative antibiotics in the setting of mandibular fracture remains in question as does the appropriate duration of therapy.

Methods: A retrospective study of all patients 18 years and older who presented with mandibular fractures to St Louis University Hospital between December 2001 and July 2006 was conducted. Collected variables included age, injury severity score, fracture type and location, preoperative antibiotic administration, antibiotic type, duration of antibiotic course, and postoperative infection.

Relaxin does not rescue coronal suture fusion in craniosynostotic rabbits.

Objectives: Craniosynostosis affects 1 in 2000 to 3000 live births and may result in craniofacial and neural growth disturbances. Histological data have shown that thick collagenous bundles are present in the sutural ligament, which may tether the osteogenic fronts, resulting in premature fusion. The hormone relaxin has been shown to disrupt collagen fiber organization, possibly preventing craniosynostosis by relaxing the sutural ligament and allowing osteogenic fronts to separate normally and stay patent.

BMP-2-mediated regeneration of large-scale cranial defects in the canine: an examination of different carriers.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on an absorbable collagen sponge is a U.S. Food and Drug Administration-approved therapy shown to be an effective means of generating bone formation in multiple clinical settings.

An algorithm for application of furlow palatoplasty to the treatment of velocardiofacial syndrome-associated velopharyngeal insufficiency.

Treatment of velocardiofacial syndrome (VCFS)-associated velopharyngeal insufficiency is controversial. Palatoplasties have variable success, and pharyngeal flaps (PPF) increase the obstructive sleep apnea risk. Our center uses Furlow palatoplasties to treat overt clefts and kinetic submucous cleft palates.

Recombinant human bone morphogenetic protein-2-induced craniosynostosis and growth restriction in the immature skeleton.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on an absorbable collagen sponge is a U.S. Food and Drug Administration-approved therapy effective at generating bone formation.

A rare case of a complete left inferior vena cava associated with the symptoms of Dunbar syndrome.

We report a case of an 82-year-old female with an anomalous left inferior vena cava. The left inferior vena cava ascends parallel and to the left of the descending abdominal aorta. At the level of the celiac trunk, the inferior vena cava courses anteriorly and to the right to reach the posterior surface of the liver.

Novel animal model of calvarial defect in an infected unfavorable wound: reconstruction with rhBMP-2.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on an absorbable collagen sponge has been shown to induce the healing of acute, primary, large-scale calvarial defects in rabbits. However, clinical circumstances often require the reconstruction of a previously infected and chronically scarred wound. This study was designed to evaluate the efficacy of rhBMP-2/absorbable collagen sponge to improve healing in the previously infected, unfavorable calvarial defect model.

Acellular dermal matrix in the treatment and prevention of exposed vertical expandable prosthetic titanium ribs.

Study Design: Case series.

Objective: To illustrate the use of acellular dermal matrix (ADM) in treatment and prevention of exposed vertical expandable prosthetic titanium rib (VEPTR) implants.

Summary Of Background Data: In the pediatric population with severe kyphoscoliosis, VEPTR is an effective tool during growth for the correction of ribcage deformity.

Divided parietal bone in plagiocephaly.

Supernumerary cranial sutures represent a rare cause of plagiocephaly. In the case of an extra suture dividing the parietal bone, the presenting features are often inconsistent with the typical presentation of deformational or synostotic plagiocephaly. Disagreement exists as to how the presence of this suture affects the shape of the skull.

Parasagittal suture after strip craniectomy.

Background: Suture reformation after strip craniectomy for nonsyndromic sagittal synostosis remains an inconsistent and underreported phenomenon. Although several theories have been proposed to account for the fate of the cranial defect, no explanation accurately matches clinical experience with the appearance of reformed sutures, ectopic sutures, and complete defect ossification postoperatively.

Methods And Results: We review the case of a 7-year-old boy who formed a parasagittal suture at the defect margin after strip craniectomy for nonsyndromic sagittal synostosis.

Scalp reconstruction: regeneration with acellular dermal matrix.

Background: Current methods of scalp reconstruction with complicating osteomyelitis of underlying bone require excision of deficient tissue and a staged reconstruction for ultimate coverage of the defect. Our group proposes a novel use of acellular dermal matrix (ADM) to preserve these deficient areas without the need for excision or staged management of osteomyelitic calvaria.

Methods And Results: From 2003 to 2008, 3 patients underwent scalp reconstruction with ADM at our facility.

Clinical anatomy of celiac artery compression syndrome: a review.

Anatomic variations are often responsible for a variety of clinical conditions. In this review we investigate compression of the celiac artery and the superior mesenteric artery by the median arcuate ligament (MAL), diaphragmatic crura, or the celiac nerve plexus. This clinical condition known as celiac artery compression syndrome (CACS) has proven controversial in definition and relevance.

Surgical anatomy of the accessory phrenic nerve.

Background: Reports place the frequency of phrenic nerve injury after cardiac operations between 10% and 85%, emphasizing the importance of an accurate anatomic description of the diaphragm's innervating nerves to reduce iatrogenic injury, length of hospitalization, and associated costs. The aim of our study was to explore the anatomic variations of the accessory phrenic nerve and relate these findings to phrenic nerve injury.

Methods: Eighty adult formalin-fixed cadavers were dissected, resulting in 160 nerve specimens.