N+1, Number Four: Reconstruction


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Abnormalities of the NippleAreolar Complex. Prevention of NippleAreolar Complex Disorders. Techniques for Correction of Nipple Hypertrophy. Techniques for Correction of Nipple Inversion. NippleAreolar Complex Reconstruction. This prospective study included six girls and two boys, with a mean age of All patients except one, were given pre- and postoperative chemotherapy. Surgery was performed for three patients with a distal femur tumor, two patients with a proximal tibial tumor and three patients who had proximal humerus, shaft of humerus and fibular tumors.

The mean operating times for first and second step procedures were 4. The healing process was radiologically assessed. After a mean follow-up of For the lower limb reconstructions, full weight bearing was possible after a mean of days range90 to following the second stage.

Mean time to bone union was 4. This two stage procedure reduces the operating time during the first stage and it also reduces early complications. Rapid bone union is objectively obtained despite major bone resection and the patients receiving chemotherapy. The induced membrane technique could be an excellent alternative for biological reconstruction after tumor resection in children.

Segmental long-bone defect due to trauma, infection or tumor resection remains a challenge as it requires complex reconstructive surgery. This procedure is a two-stage procedure. During the first stage, stabilisation is performed following the bone resection and a cement spacer is inserted followed by soft tissue repair.

The second stage is performed a few weeks later, with removal of the spacer, bone decortication and use of cancellous bone graft in the biological induced membrane. Influences of induced membranes on heterotopic bone formation within an osteo-inductive complex. Biau et al.

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More recently Villemagne et al. The purpose of this study was to assess preliminary results of the Masquelet technique in a series of eight children or adolescents treated for metaphyseal or meta-diaphyseal bone tumors. We hypothesized that the technique was safe, led to fewer complications and allowed rapid bone healing. A prospective study of induced membrane technique for reconstruction after excision of primary bone tumors was started in September Inclusion criteria were metaphyseo-diaphyseal and juxtaphyseal malignant bone tumors of long bones in children.

Exclusion criteria were patients who were older than 18 years, epiphyseal or intra-articular extension of the tumor, patients with poor prognosis for whom biological reconstruction was not recommended. Between September and April , 13 consecutive children or adolescents had induced membrane technique performed in our unit. One patient had poor response to chemotherapy and had developed lung metastases after the first stage surgery and the second stage surgery was not performed. Four other patients were excluded due to short less than one year follow-up. Results in eight patients were included in this preliminary study Table 1.

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The mean age at time of resection was I : Click here to see the Library ]; except one patient who had a low-grade periosteal osteosarcoma. The procedure of the tumor resection was performed according to principles of management of malignant bone tumors. The biopsy tract was excised in continuity with the tumor specimen.

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Particular attention was provided to cover the bone-cement junction with the cement, except for the first patient learning curve. Thermal effect of cement polymerization was minimized with the use of plastic syringes and continuous irrigation with cold saline solution. After careful hemostasis, the wound was closed with a suction drain. The mean operating time for this first stage was min range to min Table 2.

Prophylactic antibiotics were given according to the protocol, and anticoagulation therapy was not routinely used.

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Patients who had lower limb surgery were allowed partial weight bearing for the first 2 weeks followed by full weight bearing until the second stage procedure. Adjuvant chemotherapy was started 15 days after the first stage surgery. In contrast to the Masquelet recommendation for traumatic or infection bone defects, the second stage was delayed to more than 6 weeks in order to minimise the adverse effect of chemotherapy.

It was performed one month after the completion of postoperative chemotherapy 6 to 7 months after the first stage except for patients 4 and 6. Patient 6 low grade periosteal osteosarcoma did not receive post-operative chemotherapy and had the second stage surgery 2 months following the first stage procedure. Patient 4 had a fibular tumor with multiple metastases at the time of diagnosis; the first stage was performed as a definitive local management procedure.

Because of event free survival after 18 months, the patient was offered the second stage procedure.


  1. Introduction.
  2. Carpetbaggers & Scalawags;
  3. Otolaryngology: A Surgical Notebook.
  4. Reconstruction era?

As the patient had excellent function with unrestricted sporting ability, the offer of second stage surgery has not been accepted by the patient to date Table 2. The second stage was performed under general anaesthesia combined with epidural anaesthesia for patients 5 to 8 and local administration of analgesia on the graft donor site for the other patients.

Patients were positioned prone in order to harvest a large bilateral posterior cortico-cancellous iliac crest autograft.

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After the wound closure without a drain, the patients were placed in a supine position and the reconstruction surgery was performed using the previous incision. The induced membrane was carefully opened along the spacer and the first few centimetres on the adjacent bone, and the cement spacer was easily exposed with minimal dissection.

The cement was removed after fragmentation with osteotomes. The adjacent bone—cement junctions were decorticated and freshened for a cm until bleeding bone was obtained. The medullary canal was reamed. Morcellised cortico-cancellous graft was placed into the biological chamber. The membrane was closed without a drain. The mean operating time for this second stage was min range to min Table 2. Intermittent passive mobilization was started immediately after surgery as was touch weight-bearing mobilisation for lower limb resections.

Bone stiffness in children: part II. Oncology follow-up was done at three monthly intervals for the first year and six monthly intervals until 3 years. The surgical margins were histologically negative for tumors in all patients R0 according to UICC classification. Bone healing was assessed using antero-posterior AP and lateral radiographs. Each patient was evaluated by an independent observer not involved with the care of the patients. Joint range of motion, strength, muscular atrophy and lower limb length discrepancy were also assessed at the follow-up visits. Patients were followed for a mean period of A statistical analysis of multiple temperature proxies: Are reconstructions of surface temperatures over the last years reliable?

Comparative performance of paleoclimate field and index reconstructions derived from climate proxies and noise-only predictors. Xoplaki, E. European spring and autumn temperature variability and change of extremes over the last half millennium.


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  4. Animal Stories (The Natural History Animals with 158 original illustrations).
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Pauling, A. Five hundred years of gridded high-resolution precipitation reconstructions over Europe and the connection to large-scale circulation. The importance of ship log data: reconstructing North Atlantic, European and mediterranean sea level pressure fields back to Multi-centennial summer and winter precipitation variability in southern South America. Internal and external forcing of multidecadal Atlantic climate variability over the past 1, years.

ACKNOWLEDGMENT

Schneider, T. Analysis of incomplete climate data: estimation of mean values and covariance matrices and imputation of missing values. Fierro, R. Regularization by truncated total least squares.

SIAM J. Preliminary multiproxy surface air temperature field reconstruction for China over the past millennium. China Earth Sci. Emile-Geay, J. Estimating central equatorial pacific SST variability over the past millennium. Part I: methodology and validation. Continental-scale temperature variability during the past two millennia. Reconstruction of the extratropical NH mean temperature over the last millennium with a method that preserves low-frequency variability.

n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
n+1, Number Four: Reconstruction N+1, Number Four: Reconstruction
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