Segmental defect regeneration is still a clinical challenge. In this study, we investigated the feasibility of bone marrow stromal cells (BMSCs) infected with adenoviral vector containing the bone morphogenetic protein 7 gene (AdBMP7) and load-bearing to enhance bone regeneration in a critically sized femoral defect in the goat model. The defects were implanted with AdBMP7-infected BMSCs/coral (BMP7 group) or noninfected BMSCs/coral (control group), respectively, stabilized with an internal fixation rod and interlocking nails. Bridging of the segmental defects was evaluated by radiographs monthly, and confirmed by biomechanical tests. Much callus was found in the BMP7 group, and nails were taken off after 3 months of implantation, indicating that regenerated bone in the defect can be remodeled by loadbearing, whereas after 6 months in control group. After load-bearing, it is about 5 months; the mechanical property of newly formed bone in the BMP7 group was restored, but 8 months in control group. Our data suggested that the BMP7 gene-modified BMSCs and load-bearing can promote bone regeneration in segmental defects. ß
Purposely strengthening masticatory muscle movement during the denervated atrophic stage of the masseter can prolong the duration of masseter rehypertrophy.
Nasal elongation using ePTFE implantation is a feasible therapeutic approach for patients with short noses. Reliable outcomes and the absence of donor site morbidity contribute to the high patient acceptance. Meticulous surgical technique and careful patient selection are prerequisites for successful results.
Background
Various techniques for the aesthetic correction of short noses have been described, but the selection of the adequate graft material remains controversial. Previous reports have mainly focused on the application of septal cartilage or alloplastic materials for short nose elongation, but the lengthening effect is often unsatisfactory for severe short noses. We propose costal cartilage as an alternative treatment for short noses, describe the technique, and discuss outcomes, patient selection, and complications based on our 15-year experience.
Methods
From February 2004 to December 2018, 611 patients with varying degrees of short noses were included in this retrospective study. All patients underwent nose elongation surgery using a costal cartilage graft. Nasal length before and after surgery was measured based on a 3-dimensional simulation technology. Outcomes and complications including possible underlying reasons were analyzed. Patient satisfaction was evaluated using a self-assessment survey.
Results
Nasal elongation using costal cartilage was successfully achieved, with a mean increase in nasal length of 4.06 ±0.79 mm. Patients were followed up for a period of 8.5 months on average, ranging from 6 months to 8 years. Follow-up examinations demonstrated stable results. The overall complication rate was 3.8%. Complications included infection, implant extrusion, migration, deviation, visibility, prominence, and reddening of the nasal skin. Most patients (95.2%) rated their outcome as improved and much improved.
Conclusion
Nasal elongation using costal cartilage grafting is an effective therapeutic approach for patients with severe short noses. Reliable outcomes and the use of autologous tissue along with minimal donor site morbidity contribute to the high patient acceptance. Meticulous surgical technique and careful patient selection are prerequisites for successful results.
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