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This article reports the treatment of 2 cases of mandibular third molar displacement into deep fascial spaces during attempted extraction, 1 of which resulted in acute infection. In addition to treatment approaches, the article reviews the risk factors for tooth displacement and techniques that may be used for its prevention. In both of the reported cases, after tooth extraction procedures resulted in the displacement of a third molar, the correct location of the tooth was ascertained by 3-dimensional imaging. The displaced tooth was removed via intraoral access while the patient was under general anesthesia. Both patients healed without postsurgical complications, confirming the success of the treatment. [ABSTRACT FROM AUTHOR]

The main aim of our study was to study morphological state of the autograft from the fascia of the temporal muscle in myringoplasty. Until now, there is no consensus on issue of which fabrics are more suitable for use in the eardrum. We decided to study of use of an autograft from the fascia of the temporal muscle for myringoplasty in rabbits in the experiment, and in patients with chronic dry mesotympanitis. An electron microscopic examination of the fascia taken immediately, after 10, 20 min and 1 h after sampling. It was found that there are no gross destructive changes in the fascia structure. Minor changes are detected in the form of a light disorganization of the collagen complex, granular dystrophy with an increase in cell. Inflammatory diseases of the middle ear are widespread among population of all age groups. In the experiment, a positive result was obtained in 29 (82.8%) rabbits. In our research we performed morphological features of xenograft engraftment in an experimental animal on 3, 7, 14, 21 days and 1-3 months. In period from 3 days to 3 months after operation, the animals were euthanized by an air embolism and subjected to pathological examination. Then recovered xenograft, was examined macro and microscopically. Pieces were fixed in a 10% solution of neutral formalin. After washing with water, dehydration was carried out in alcohol and chloroform, and after, waxed with paraffin. Histological sections were stained with hematoxylin-eosin. Collagen fibers were detected by method of Vann-Gieson. [ABSTRACT FROM AUTHOR]

Abstract: This study was designed to compare the analgesic efficacy of levobupivacaine patient controlled analgesia epidural versus patient controlled analgesia with fascia lliaca compartment block. In patients undergoing fixation of fracture neck femur. Methods: Sixty patients ASA II&III undergoing fixation of fracture neck femur were randomly allocated into two groups (n =30). Group E: Epidural group given levobupivacaine 0.25% 15ml before induction of general anesthesia, followed by postoperative PCEA with levobupivacaine (0.125%). Group F: Fascia iliaca block group given levobupivacaine 0.25% 30ml through the catheter before induction of general anesthesia, followed by postoperative patient controlled fascia illiaca analgesia with levobupivacaine (0.125%). Severity of postoperative pain at rest in 24h using VAS, number of patients required additional analgesia (tramadol) in 24h, doses of postoperative 24h tramadol consumed, postoperative mean arterial blood pressure and heart rate were recorded. Results: The severity of postoperative pain was statistically significantly less in E group, number of patients required tramadol in 24h were statistically significantly less in E group than F group, postoperative tramadol consumed was statistically significantly less in E group than F group. Conclusion: PCEA with levobupivacaine (0.125%) was associated with satisfactory analgesia than patient controlled analgesia with fascia iliaca block in patients undergoing fixation of fracture neck femur. [Copyright &y& Elsevier]

Abstract: Efficacy of dexmedetomidine addition to bupivacaine on the quality of blind fascia iliaca compartment block in children undergoing femur fracture surgery. Objectives: The objectives of this study were designed to detect the effects of addition of dexmedetomidine to bupivacaine on the quality of blind fascia iliaca compartment block and its possible side effects in children undergoing fracture femur surgery. Methods: This study was conducted on 28 children (2–6years of age), scheduled for fracture femur surgery. Children were randomly allocated to receive either 0.25% bupivacaine 1mlkg−1 (B group), or 0.25% bupivacaine 1mlkg−1 with dexmedetomidine 2μgkg−1 (BD group). Anesthesia was maintained with sevoflurane 1–1.5 minimum alveolar concentration. Intraoperative sevoflurane concentration, hemodynamic, postoperative emergence delirium, sedation scores and pain scores were recorded. Duration of surgery and emergence time were recorded. Postoperative complications such as (nausea and vomiting, respiratory depression, purities, hypotension and bradycardia) were reported. Results: Compared to the group B, patients received bupivacaine–dexmedetomidine for fascia iliaca compartment block had lower intraoperative sevoflurane concentration, higher sedation score, longer duration of postoperative analgesia, less use of rectal paracetamol for the first 24h postoperatively and less number with postoperative agitation. No patients developed postoperative respiratory depression, purities, hypotension or bradycardia. Conclusion: The present study concluded that the combined use of bupivacaine–dexmedetomidine for fascia iliaca compartment block in children provided significant reduction of end-tidal sevoflurane concentration, remarkable hemodynamic stability, significant postoperative analgesia with lower postoperative analgesics requirements without any undesirable complications. [Copyright &y& Elsevier]

Background: Locoregional recurrence occurs in approximately 20% of patients with melanoma and is associated with a significantly worse prognosis. Standards are well established for peripheral margins; however, there is insufficient evidence regarding depth of resection. Methods: Retrospective review of 964 patients undergoing excision of trunk or extremity melanoma ≥1 mm thick during a 29-year period at a tertiary academic center. Multivariate analysis and hazard ratios were used to determine the effect of excision of the deep muscular fascia on locoregional recurrence. Results: A total of 278 (29%) patients underwent resection of the muscular fascia. Of these patients, 18 (6%) developed local, 33 (12%) developed in-transit, and 68 (24%) developed nodal recurrence within 5 years. A total of 686 (71%) patients underwent excision of their primary melanoma with preservation of the muscular fascia. Of these patients, 40 (6%) developed local, 30 (4%) developed in-transit, and 84 (12%) developed nodal recurrence at 5 years. In multivariate analysis excision of the deep muscular fascia was an independent predictor of locoregional recurrence in patients treated with sentinel lymph node biopsy. Specifically, fascia resection was associated with a 2.5-fold increased risk of nodal recurrence but not associated with local recurrence or overall survival. Conclusion: On the basis of no demonstrated advantage for resection of the deep muscular fascia, but potential for increased risk of intralymphatic recurrences, we recommend preservation of the deep muscular fascia during resection of primary cutaneous melanoma. [ABSTRACT FROM AUTHOR]

Summary: The anterior scoring technique is criticised for a higher risk of haematoma related complications while the suture techniques for suture-extrusion and recurrence. Horlock et. al. described a suture otoplasty with addition of a postauricular fascial flap to reduce suture extrusion and noted recurrence rates of 8%. We report the senior author’s experience with this technique in 227 consecutive cases. All cases were done by or under supervision of the senior author and the data collected prospectively. Complications, recurrence, revision rate and results as recorded were analysed. A total of 10 (7 early 3 late) complications were recorded (4.4%). Suture extrusion (n = 6, 2.64%), Keloids (n = 3, 1.32%), Infection, anterior skin necrosis (n = 1 each, 0.44%). A total of 6 unilateral and 5 bilateral cases had a recurrence (3.67% total ears) and 97% of recorded outcomes were reported as good or excellent results. The low complication rate seems to support the hypothesis that the fascial flap prevents suture extrusion and reduces risk of recurrence. Lack of Anterior dissection avoids risks of bleeding and haematoma. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The temporoparietal fascia flap (TPFF) is a versatile tool in head and neck reconstruction. This article aims to describe the spectrum of TPFF applications through a series of case studies and related review of the literature. Methods: Medical records were reviewed to identify cases that represent major TPFF application categories. A literature review was performed to support the presentation and discussion of each case category. Results: Seven cases were identified each representing a distinct application category. These included auricular reconstruction, hair-bearing tissue transfer, facial soft tissue augmentation, cutaneous and mucosal oncologic defect repair, reconstruction after salvage laryngectomy, skull base reconstruction, and orbital reconstruction. Conclusion: The TPFF is a uniquely versatile tool in head and neck reconstructive surgery. Outstanding in its pliable, ultra-thin yet hardy and highly vascular form, the temporoparietal fascia flap is a workhorse for the creative head and neck reconstructive surgeon. [ABSTRACT FROM AUTHOR]

The article presents a study on the association between preoperative flexion contracture (FC) and self-reported disability in patients who are undertaking surgical release by dermofasciectomy or fasciectomy. The study uses a DASH questionnaire to assess the 154 patients who are enrolled in prospective randomized trials. Results show that with the utilization of DASH questionnaire, the relationship between severity of FC and functional disability appear to be very weak or even absent.

Summary: Aim: Compared with those for free-fat grafts, resorption rates for vascularized adipose tissue transfers are very low. We analysed benefits of transfer of dermal–adipose grafts after prelamination upon the temporal fascia in reconstruction of facial contour defects. Patients and methods: Among 8 patients operated on between 2005 and 2008, facial contour anomalies had resulted from trauma in 5, while the remaining 3 had abnormalities with a congenital, postinfectious, or iatrogenic aetiology. In the first-stage operation, a dermal–adipose graft was taken from the inguinal region and prelamination upon the superior surface of the temporal fascia. After 5.5 months, the prelaminated dermal–adipose–fascial flap was raised as an island flap, passed through a subcutaneous tunnel in the temporal region, and set into the defect site. Results: Satisfactory cosmetic results were achieved in all patients. Except for a temporary frontal nerve palsy in 1 patient, no early or late complications resulted from this procedure. Conclusion: Prelamination of dermal–adipose grafts upon the temporoparietal fascia is useful in reconstruction of soft tissue defects requiring volume augmentation. [Copyright &y& Elsevier]

Abstract: Dupuytren’s disease is characterized by contracture of the palmar and digital hand fascia resulting in characteristic nodule and/or cord formation within the hand. This results in flexion deformity of the digits with subsequent impaired function. The pertinent epidemiology, aetiology and pathophysiology of this disease are discussed in this review. In addition, current principles of treatment of the hand contracture that develops as a result of this disease, both conservative and surgical, are highlighted in this review. [ABSTRACT FROM AUTHOR]

Summary: Children with severe congenital blepharoptosis are at risk of developing amblyopia. For this reason, ptosis repair is indicated as soon as the diagnosis is made. Frontalis suspension of the upper lid is an effective and simple method of treatment. This study reports on the long-term outcome of frontalis suspension surgery for congenital ptosis using autogenous sling material. Twelve children with severe congenital ptosis underwent frontalis suspension surgery using autologous fascia lata or temporal fascia. The results were assessed with a mean follow-up period of 8 years. Eleven children had good or excellent functional and aesthetic results. There were no cases of recurrence or overcorrection. Frontalis suspension using autologous material is a harmless procedure, which does not alter the upper eyelid structures. It is an effective procedure in the long term. In our opinion, it is the technique of choice to treat young children with severe congenital ptosis. [Copyright &y& Elsevier]

Summary: Nasal dorsal irregularities are troublesome for both patient and surgeon, especially in patients with thin nasal dorsal skin. Many types of grafts have been used for nasal contouring; however, in this article, we report the use of fascia lata (FL) graft for dorsal contouring and camouflage in 63 patients who underwent rhinoplasty between May 2004 and December 2005. There were 26 male and 37 female patients, with ages ranging from 18 to 43 years (mean age: 28.7). Of the 63 patients, 49 underwent primary rhinoplasty, while 14 were secondary cases. An informed consent was obtained from all patients for the use of FL graft. The graft was harvested from the right lateral thigh. A simple method was used to place the graft over the nasal dorsum. Postoperative follow-up period was between 14 and 26 months (mean: 20). Clinical evaluation was made by inspection, palpation and photographic documentation. In addition, a questionnaire related to patient satisfaction and donor-site morbidity was sent to patients 1 year after surgery. All patients had satisfactory aesthetic results, and no apparent irregularities were observed over the nasal dorsum. The questionnaire results showed that all patients, but one, were satisfied with surgery, and were not concerned about donor-site scar; however, one patient had a donor-site morbidity. This study conclusively shows that TLF graft is a reliable, simple method for camouflaging any postoperative dorsal irregularities, particularly in patients with thin nasal skin. [Copyright &y& Elsevier]

Objective: This study was undertaken to determine the effects of rectovaginal fascia reattachment on symptoms and vaginal topography.Study Design: Standardized preoperative and postoperative assessments of vaginal topography (the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons) and 5 symptoms commonly attributed to rectocele were used to evaluate 66 women who underwent rectovaginal fascia reattachment for rectocele repair. All patients had abnormal fluoroscopic results with objective rectocele formation.Results: Seventy percent (n = 46) of the women were objectively assessed at 1 year. Preoperative symptoms included the following: protrusion, 85% (n = 39); difficult defecation, 52% (n = 24); constipation, 46% (n = 21); dyspareunia, 26% (n = 12); and manual evacuation, 24% (n = 11). Posterior vaginal topography was considered abnormal in all patients with a mean Ap point (a point located in the midline of the posterior vaginal wall 3 cm proximal to the hymen) value of -0.5 cm (range, -2 to 3 cm). Postoperative symptom resolution was as follows: protrusion, 90% (35/39; P <.0005); difficult defecation, 54% (14/24; P <.0005); constipation, 43% (9/21; P =.02); dyspareunia, 92% (11/12; P =.01); and manual evacuation, 36% (4/11; P =.125). Vaginal topography at 1 year was improved, with a mean Ap point value of -2 cm (range, -3 to 2 cm).Conclusion: This technique of rectocele repair improves vaginal topography and alleviates 3 symptoms commonly attributed to rectoceles. It is relatively ineffective for relief of manual evacuation, and constipation is variably decreased. [ABSTRACT FROM AUTHOR]

Describes the use of synthetic grafts in repairing fascial dehiscence complicated by fascial necrosis and infection after obstetric and gynecologic operations. Prevention of primary closure of wound dehiscence with extensive fascial debridement; Role of synthetic grafts in the primary closure of large fascial defects.

We present a silicon sheet for temporary wound covering and gradual wound closure after open fasciotomy. Fasciotomy was performed in a total of 70 limbs with compartment syndrome (CS). The main etiology of CS was predominantly vascular. All patients were treated with a silicon sheet to cover the soft tissue defect and gradually reapproximate the skin margins. In 53% of the patients, a delayed final wound closure was achieved after a mean of 11.9 days. This method allows final closure of fasciotomy wounds without scar contractures, marginal necrosis, infection, or significant pain. [ABSTRACT FROM AUTHOR]

The article discusses compartment syndrome and fasciotomy. According to the definition of Fredrick A. Matsen, the syndrome is a condition wherein the increased pressure content within a limited space compromises tissues' function and circulation within that space. It notes that it has four essential components including the limiting envelope, increased tissue pressure and abnormalities in neuromuscular tissue. Meanwhile, fasciotomy is a surgical incision of fascia to manage compartment syndrome.

Purpose: We undertook a cost-utility analysis to compare traditional fasciectomy for Dupuytren with 2 new treatments, needle aponeurotomy and collagenase injection. Methods: We constructed an expected-value decision analysis model with an arm representing each treatment. A survey was administered to a cohort of 50 consecutive subjects to determine utilities of different interventions. We conducted multiple sensitivity analyses to assess the impact of varying the rate of disease recurrence in each arm of the analysis as well as the cost of the collagenase injection. The threshold for a cost-effective treatment is based on the traditional willingness-to-pay of $50,000 per quality-adjusted life years (QALY) gained. Results: The cost of open partial fasciectomy was $820,114 per QALY gained over no treatment. The cost of needle aponeurotomy was $96,474 per QALY gained versus no treatment. When we performed a sensitivity analysis and set the success rate at 100%, the cost of needle aponeurotomy was $49,631. When needle aponeurotomy was performed without surgical center or anesthesia costs and with reduced hand therapy, the cost was $36,570. When a complete collagenase injection series was priced at $250, the cost was $31,856 per QALY gained. When the injection series was priced at $945, the cost was $49,995 per QALY gained. At the market price of $5,400 per injection, the cost was $166,268 per QALY gained. Conclusions: In the current model, open partial fasciectomy is not cost-effective. Needle aponeurotomy is cost-effective if the success rate is high. Collagenase injection is cost-effective when priced under $945. Type of study/level of evidence: Economic and Decision Analysis II. [ABSTRACT FROM AUTHOR]

Summary: A post-traumatic cyst is a rare complication of significant soft tissue trauma. It occurs at the junction between the subcutaneous fat and underlying fascia, when a large, subcutaneous haematoma fails to resolve, developing into a chronic, fluid-filled cyst, lined with fibrous tissue. This results in a swelling that persists for years, gradually increasing in size, often without causing significant discomfort to the patient. Clinically and radiologically these swellings may be mistaken for neoplastic lesions. They can be difficult to treat, are refractory to conservative management and have a high rate of recurrence following surgical excision. Careful monitoring and early treatment of persistent postoperative seroma is advocated. [Copyright &y& Elsevier]