The Controlling Nutritional Status (CONUT) Score for Prediction of Microvascular Flap Complications in Reconstructive Surgery

Microvascular flap surgery is a widely acknowledged procedure for significant defect reconstruction. Multiple flap complication risk factors have been identified, yet there are limited data on laboratory biomarkers for the prediction of flap loss. The controlling nutritional status (CONUT) score has demonstrated good postoperative outcome assessment ability in diverse surgical populations. We aim to assess the predictive value of the CONUT score for complications in microvascular flap surgery. This prospective cohort study includes 72 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws for analysis of full blood count, total plasma cholesterol, and albumin concentrations were collected on the day of surgery before crystalloid infusion. Postoperative data on flap complications and duration of hospitalization were obtained. The overall complication rate was 15.2%. True flap loss with vascular compromise occurred in 5.6%. No differences in flap complications were found between different areas of reconstruction, anatomical flap types, or indications for surgery. Obesity was more common in patients with flap complications (p = 0.01). The CONUT score had an AUC of 0.813 (0.659-0.967, p = 0.012) for predicting complications other than true flap loss due to vascular compromise. A CONUT score > 2 was indicated as optimal during cut-off analysis (p = 0.022). Patients with flap complications had a longer duration of hospitalization (13.55, 10.99-16.11 vs. 25.38, 14.82-35.93; p = 0.004). Our findings indicate that the CONUT score has considerable predictive value in microvascular flap surgery.

Immunohistochemical evaluation after Sr-enriched biphasic ceramic implantation in rabbits femoral neck: comparison of seven different bone conditions

Strontium (Sr) has shown effectiveness for stimulating bone remodeling. Nevertheless, the exact therapeutic values are not established yet. Authors hypothesized that local application of Sr-enriched ceramics would enhance bone remodeling in constant osteoporosis of rabbits' femoral neck bone. Seven different bone conditions were analyzed: ten healthy rabbits composed a control group, while other twenty underwent ovariectomy and were divided into three groups. Bone defect was filled with hydroxyapatite 30% (HAP) and tricalcium phosphate 70% (TCP) granules in 7 rabbits, 5% of Sr-enriched HAP/TCP granules in 7, but sham defect was left unfilled in 6 rabbits. Bone samples were obtained from operated and non-operated legs 12 weeks after surgery and analyzed by histomorphometry and immunohistochemistry (IMH). Mean trabecular bone area in control group was 0.393 mm2, in HAP/TCP - 0.226 mm2, in HAP/TCP/Sr - 0.234 mm2 and after sham surgery - 0.242 mm2. IMH revealed that HAP/TCP/Sr induced most noticeable increase of nuclear factor kappa beta 105 (NFkB 105), osteoprotegerin (OPG), osteocalcin (OC), bone morphogenetic protein 2/4 (BMP 2/4), collagen type 1α (COL-1α), interleukin 1 (IL-1) with comparison to intact leg; NFkB 105 and OPG rather than pure HAP/TCP or sham bone. We concluded that Sr-enriched biomaterials induce higher potential to improve bone regeneration than pure bioceramics in constant osteoporosis of femoral neck bone. Further studies on bigger osteoporotic animals using Sr-substituted orthopedic implants for femoral neck fixation should be performed to confirm valuable role in local treatment of osteoporotic femoral neck fractures in humans.

Microsurgical reconstruction of oral defects with free flaps for patients with oral cancer: an 8 year experience with 153 consecutive cases

OBJECTIVE

Oral squamous cell carcinoma (OSCC) is a common type of cancer affecting people worldwide, with still large proportion of patients diagnosed with the disease in the advanced stage. Due to free vascularised tissue transfers, radical cancer treatment and immediate reconstruction are feasible as a one-stage procedure. The aim of this paper is to evaluate retrospectively our experience with free flap reconstruction of oral defects for patients with oral malignancies in advanced stages.

MATERIAL AND METHODS

During the 8-year period, 153 patients with oral cancer had undergone simultaneous extirpation of tumor with or without suspicious lymph node removal and reconstruction of the defect with free flap. A total of 157 free-flap reconstructions had been performed for 153 patients. Accordingly, 116 patients had reconstruction of oral soft tissue defect, but 37 patients had complex soft tissue and bone defect reconstruction.

RESULTS

132 patients had successful free flap surgery with uneventful post surgery period. Flap success rate was 96.8%. Donors site was closed primarily in 58 cases, skin graft was used in 102 cases. Five patients (3.2%) died during post surgery period. Average hospital stay was 20,5 days (from 8 till 44 days). There was no statistically significant correlation found between the patient's age and hospital stay, but hospital stay increased with tumor size (p>0.05).

CONCLUSION

The application of the best possible reconstruction method that contributes to the fulfillment of expectations and provision of a good functional and esthetical result is enabled by setting proper, realistic reconstruction goals. Microvascular reconstruction with free flaps for oral defects is a safe method with a very high success rate (96.8%).

Does Local Application of Strontium Increase Osteogenesis and Biomaterial Osteointegration in Osteoporotic and Other Bone Tissue Conditions: Review of Literature

Osteoporosis and other pathological bone conditions can impair bone regeneration properties, consuming in increased morbidity and decreased quality of life. Changes of bone healing can result in poor osteointegration and surgical failures if implants are used. To overcome and facilitate bone regeneration, more attempts are made to develop an ideal synthetic scaffold with better biocompatibility, osteoconductivity, bioactivity, osteoinductivity and interconnected porosity. It is considered that strontium, being similar to calcium, can be incorporated into the mineral phase of the bone remodeling. This quality had led strontium to be used as an osteoporotic medication to improve quality of bone and to reduce the risk of bone fractures. Also local application of strontium has been widely used within different biomaterials in tissue engineering researches.

In this review authors wanted to provide an overview about strontium, its mechanisms of action in bone tissue and initiated changes of bone remodeling within biomaterials.