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Journal of Maxillofacial and Oral... Jun 2023Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various... (Review)
Review
BACKGROUND
Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions.
OBJECTIVE
The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials.
MATERIALS AND METHODS
PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale.
RESULTS
A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive.
CONCLUSION
Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12663-023-01869-9.
PubMed: 37122786
DOI: 10.1007/s12663-023-01869-9 -
Journal of the European Academy of... Jan 2017Localized scleroderma (LoS) is a rare inflammatory skin disorder that affects the dermis and sometimes subcutaneous tissues. LoS can have very long periods of quiescence... (Review)
Review
Localized scleroderma (LoS) is a rare inflammatory skin disorder that affects the dermis and sometimes subcutaneous tissues. LoS can have very long periods of quiescence followed by reactivation, but the progression or activity of the disease is difficult to measure. To review the measuring tools used for the evaluation of LoS activity, to choose the most appropriate technique to facilitate progress towards properly assessing the disease, a systematic review of the literature was carried out using the PubMed MEDLINE. Sixty-three studies describing groups of children, adults or both were reviewed and included in the analysis. Case reports were excluded. The analysed papers were published between June 1986 and February 2016. Data were extracted with a focus on instruments measuring the clinical signs of LoS, health-related quality of life (HRQoL), laboratory tests and imaging techniques. Perusal of the literature confirmed that clinical characteristics of the lesions were used to identify activity and scoring systems that focused on a series of signs, and were initially validated in cases of childhood-onset disease; however, there were no data concerning the adult-onset form of the disease. Adult patients with LoS scored lower on HDLQI than those with paediatric-onset LoS. No validated biological markers were available as correlative laboratory parameters of LoS activity. For infrared thermography, ultrasound and other imaging techniques, the features of active lesions were described, but were only useful with appropriate clinical correlation. Measuring tools have not been prospectively validated yet. Summarizing, scoring methods seem to provide the most adequate assessment of LoS and deserve to be further investigated. Combined imaging techniques create optimal conditions for the proper interpretation of the temperature at the skin surface, as well as the structure and vascularity of LoS lesions. Additional scores, musculoskeletal or neuroimaging techniques and laboratory parameters are needed for the specific disease subtypes to monitor extracutaneous manifestations.
Topics: Adult; Humans; Scleroderma, Localized; Visual Analog Scale
PubMed: 27401109
DOI: 10.1111/jdv.13790 -
Plastic and Reconstructive Surgery Nov 2012Use of biologically engineered acellular dermal matrices in the upper and lower extremities is increasingly recognized as a means of achieving definitive healing in the... (Review)
Review
BACKGROUND
Use of biologically engineered acellular dermal matrices in the upper and lower extremities is increasingly recognized as a means of achieving definitive healing in the setting of both acute and chronic injuries but data and evidence supporting their use are limited. The authors performed this systematic review to identify all available evidence for the use of matrices in nonburn extremity reconstruction.
METHODS
A systematic review of the Cochrane and MEDLINE databases was performed to identify all reports of the application of matrices in wounds of the upper and lower extremities. Reports that included fewer than five patients and that involved cellular seeding, nonhuman studies, and burn injuries were excluded. Studies were evaluated for quality of statistical measures and outcomes, and a level of evidence was assigned in accordance with the American Society of Plastic Surgeons' Rating Levels of Evidence.
RESULTS
Of an initial 2422 reports, 13 primary reports were identified (10 case series and three randomized controlled trials) representing a total of 432 patients and 441 discrete wounds. After evidence review, 10 of these studies represented level IV evidence, two studies represented level II evidence, and one study achieved level I evidence.
CONCLUSIONS
Extremity wound management continues to rely on adequate vascular supply, débridement with eradication of infection, off-loading, and/or immobilization. Current data, although limited, appear to support the use of acellular dermal matrices in chronic and acute injuries where there is exposed bone, tendon, and/or muscle. They may provide a simple technique to achieve timely and durable tissue coverage in extremity wounds.
Topics: Acellular Dermis; Arm; Arm Injuries; Chondroitin Sulfates; Chronic Disease; Collagen; Evidence-Based Medicine; Humans; Leg; Leg Injuries; Leg Ulcer; Muscle, Skeletal; Prospective Studies; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Retrospective Studies; Skin, Artificial; Soft Tissue Injuries; Tendon Injuries; Tissue Scaffolds; Treatment Outcome; Wound Healing
PubMed: 23096978
DOI: 10.1097/PRS.0b013e3182615703 -
The British Journal of Dermatology Feb 2015Skin ageing is associated with a flattening of the dermoepidermal junction and a less effective anchoring system, predisposing to bulla formation, trauma and shear-type... (Meta-Analysis)
Meta-Analysis Review
Skin ageing is associated with a flattening of the dermoepidermal junction and a less effective anchoring system, predisposing to bulla formation, trauma and shear-type injuries. An artificial and controlled technique for standardized dermoepidermal separation is the suction blister method, whereby the strength of dermoepidermal adhesion is characterized by blistering time. To identify and quantify influencing factors on blistering time in healthy humans. A search in the Medline and Embase databases (1946 to June 2014) and in reference lists was conducted. In total, results of 146 suction blister experiments in 3418 individuals reported in 59 publications were analysed. The median blister diameter was 6 mm (IQR 5-6) and the median suction pressure was -210 mmHg (IQR -200 to -300), resulting in a median blistering time of 75 min (IQR 48-120). In the multivariate model, skin temperature and age were the strongest predictors for suction blistering time (P < 0·001, R(2) adjusted = 0·707). This strong association between temperature and suction blistering indicates that the dermoepidermal junction loses its strength with increasing skin temperature. This finding supports the practice of skin and tissue cooling to prevent injuries. The increased vulnerability of the skin seems to exist irrespectively of applied mechanical loads. We conclude that blistering time is an important and clinically relevant (outcome) parameter measuring the structural and mechanical integrity of deeper cutaneous layers.
Topics: Abdomen; Adult; Blister; Dermis; Epidermis; Female; Forearm; Humans; Male; Pressure; Skin Aging; Skin Physiological Phenomena; Suction
PubMed: 25065915
DOI: 10.1111/bjd.13298 -
The Annals of Pharmacotherapy Aug 2023This article reviews clinical trials to assess the efficacy, safety, and clinical application of once-daily roflumilast 0.3% cream for the treatment of plaque psoriasis. (Review)
Review
OBJECTIVE
This article reviews clinical trials to assess the efficacy, safety, and clinical application of once-daily roflumilast 0.3% cream for the treatment of plaque psoriasis.
DATA SOURCES
A systematic review of the literature was performed using the terms OR OR in MEDLINE (PubMed) and EMBASE databases between January 2012 and October 2022. Bibliographies and the ClinicalTrials.gov website were also searched to identify further studies.
STUDY SELECTION AND DATA EXTRACTION
Studies written in English and relevant to pharmacology, clinical trials, and safety were considered for inclusion.
DATA SYNTHESIS
In two 8-week phase III clinical trials, disease severity as assessed by a score of "clear" or "almost clear" and a 2-point improvement on Investigator Global Assessment (IGA) was 42.4% and 37.5% at week 8 in DERMIS-1 and DERMIS-2, respectively, compared to 6.1% and 6.9% in the control groups. In the 52-week phase III trial, treatment success rates for plaque psoriasis and intertriginous psoriasis were similar to the 8-week data with 45% of patients in the treatment group were evaluated as an IGA of "clear" or "almost clear" at week 52.
RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS
Roflumilast is a new US Food and Drug Administration (FDA)-approved topical phosphodiesterase inhibitor that shows promise for the treatment of mild-severe plaque psoriasis. It is an effective and safe topical nonsteroidal alternative to currently available topical corticosteroids, but there are currently no comparative studies with other psoriasis treatments.
CONCLUSION
Roflumilast is effective and safe for the treatment of plaque psoriasis and intertriginous psoriasis. Future trials should compare its efficacy and tolerability with that of the older, clinically established topical corticosteroids. Prohibitive factors may include limited patient adherence to topical treatments and cost.
Topics: Humans; Adrenal Cortex Hormones; Aminopyridines; Dermatologic Agents; Immunoglobulin A; Psoriasis; Severity of Illness Index; Treatment Outcome; Clinical Trials as Topic
PubMed: 36420929
DOI: 10.1177/10600280221137750 -
The British Journal of Oral &... Oct 2022Surgical management of temporomandibular joint (TMJ) ankylosis involves various techniques from which interpositional arthroplasty (IPA) involves using several... (Meta-Analysis)
Meta-Analysis Review
Comparison of surgical outcomes related to interpositional arthroplasty materials used in patients with temporomandibular joint ankylosis: a systematic review and meta-analysis.
Surgical management of temporomandibular joint (TMJ) ankylosis involves various techniques from which interpositional arthroplasty (IPA) involves using several materials. The objectives of this study were to assess and compare post arthroplasty maximum mouth opening (MMO), symptoms like pain and discomfort in jaw opening and movements, failures such as reankylosis, neurosensory disturbances, and the effect of confounding variables such as age, gender, physiotherapy, etc. The search (conducted in September, 2021) included studies published in English on otherwise healthy individuals (11 months to 88 years) having undergone arthroplasty with a minimum of six months' follow up. We used search engines such as Cochrane database, PubMed, Embase, Scopus, EBSCO host, Pro quest, J gate, Google Scholar, and manual search to include books and grey literature. Randomised clinical (RCT) and non-randomised clinical trials, observational studies, case series and reports meeting the inclusion criteria were selected. Two reviewers (HD and NP) independently extracted the data. Risk of bias was assessed using the Cochrane tool, Rangel checklist, and Joanna Briggs Institute. Data were analysed using RevMan (Version 5.4). Fifty studies with 1524 participants (442 bilateral and 891 unilateral joints) were included; six RCTs, 31 retrospective, 10 prospective, and three case series and reports. Amongst all interpositional materials, the highest increase in mouth opening was seen with dermis fat graft with a mean difference (Pooled MD) being 35.29mm (95% CI [32.36 to 38.22]). Comparison of temporalis myofascial with gap arthroplasty (GA) showed significant increase in MMO (Pooled MD in mm 1.30 95% CI [0.14 to 2.45]). Recurrence was significantly reduced when (IPA) was used, compared with GA (Risk difference 0.08mm 95% CI [-0.15 to -0.02]) and for Temporalis Myofascial Flap (TMF) when compared with GA (Risk difference -0.07mm 95% CI [-0.15 to 0]). Higher odds for developing neurosensory disturbances were seen with Al-Kayat Bramley incision (Pooled OR 0.11 95% CI [0.04 to 0.34]) compared to pre-auricular incision (Pooled OR 0.03 95% CI [0.01 to 0.09]). IPA was superior to GA with respect to maximum mouth opening (MMO) (Pooled MD in mm 1.21 95% CI [0.41 to 2.07]). Dermis fat graft offers the highest MMO. The overall quality of evidence for RCTs is poor while that of observational studies is moderate as per the relevant assessment of quality of evidence. More research with appropriate study designs is needed. Similar to the findings from the previous reviews, outcomes with IPA were superior when compared to GA in terms of mouth opening and less recurrence.
Topics: Ankylosis; Arthroplasty; Humans; Prospective Studies; Retrospective Studies; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35906111
DOI: 10.1016/j.bjoms.2022.05.005 -
BMJ Clinical Evidence Jan 2009Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades... (Review)
Review
INTRODUCTION
Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades it from 1 to 5. The annual incidence of ulcers among people with diabetes is 2.5-10.7% in resource-rich countries, and the annual incidence of amputation for any reason is 0.25-1.8%.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent foot ulcers and amputations in people with diabetes? What are the effects of treatments in people with diabetes with foot ulceration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 41 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: debridement, human cultured dermis, human skin equivalent, patient education, pressure off-loading with felted foam or pressure-relief half-shoe, pressure off-loading with total-contact or non-removable casts, screening and referral to foot care clinics, systemic hyperbaric oxygen for non-infected ulcers, systemic hyperbaric oxygen in infected ulcers, therapeutic footwear, topical growth factors, and wound dressings.
Topics: Amputation, Surgical; Debridement; Diabetic Foot; Foot Ulcer; Humans
PubMed: 19445774
DOI: No ID Found -
Frontiers in Immunology 2020Skin fibrosis is the result of aberrant processes leading to abnormal deposition of extracellular matrix (ECM) in the dermis. In healthy skin, keratinocytes participate...
Skin fibrosis is the result of aberrant processes leading to abnormal deposition of extracellular matrix (ECM) in the dermis. In healthy skin, keratinocytes participate to maintain skin homeostasis by actively crosstalking with fibroblasts. Within the wide spectrum of fibrotic skin disorders, relatively little attention has been devoted to the role of keratinocytes for their capacity to participate to skin fibrosis. This systematic review aims at summarizing the available knowledge on the reciprocal interplay of keratinocytes with fibroblasts and their soluble mediators in physiological states, mostly wound healing, and conditions associated with skin fibrosis. We performed a systematic literature search on PubMed to identify human studies investigating the keratinocyte characteristics and their interplay with fibroblasts in physiological conditions and within fibrotic skin disorders including hypertrophic scars, keloids, and systemic sclerosis. Studies were selected according to pre-specified eligibility criteria. Data on study methods, models, stimuli and outcomes were retrieved and summarized according to pre-specified criteria. Among the 6,271 abstracts retrieved, 73 articles were included, of which 14 were specifically dealing with fibrotic skin pathologies. Fifty-six studies investigated how keratinocyte may affect fibroblast responses in terms of ECM-related genes or protein production, phenotype modification, and cytokine production. Most studies in both physiological conditions and fibrosis demonstrated that keratinocytes stimulate fibroblasts through the production of interleukin 1, inducing keratinocyte growth factor (KGF) and metalloproteinases in the fibroblasts. When the potential of keratinocytes to modulate collagen synthesis by healthy fibroblasts was explored, the results were controversial. Nevertheless, studies investigating keratinocytes from fibrotic skin, including keloids, hypertrophic scar, and scleroderma, suggested their potential involvement in enhancing ECM deposition. Twenty-three papers investigated keratinocyte proliferation differentiation and production of soluble mediators in response to interactions with fibroblasts. Most studies showed that fibroblasts modulate keratinocyte viability, proliferation, and differentiation. The production of KGF by fibroblast was identified as key for these functions. This review condenses evidence for the active interaction between keratinocytes and fibroblasts in maintaining skin homeostasis and the altered homeostatic interplay between keratinocytes and dermal fibroblasts in scleroderma and scleroderma-like disorders.
Topics: Animals; Cicatrix, Hypertrophic; Fibroblasts; Fibrosis; Humans; Keloid; Keratinocytes; Scleroderma, Systemic; Skin; Wound Healing
PubMed: 32477322
DOI: 10.3389/fimmu.2020.00648 -
Aesthetic Surgery Journal Dec 2023Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular dermal matrix (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation, theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, with a variety of ADMs.
OBJECTIVES
The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy of ADM types.
METHODS
The PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type, with a chi-squared test performed for analysis. Identified studies with a comparative group were included in a meta-analysis utilizing risk ratio (RR) to assess the efficacy of ADM.
RESULTS
Nine articles including ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion, with a total of 481 breasts. Strattice was the most commonly utilized ADM (n = 391), followed by AlloDerm (n = 57). There was a statistically significant difference in efficacy of ADM among the studied ADM types (P < .001). AlloDerm, FlexHD, and DermaMatrix had the lowest capsular contracture rates (0%). NeoForm and SurgiMend had the highest capsular contracture rates (each 25%, but with n = 4 and n = 8, respectively). Strattice had a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduced the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared with conventional treatment.
CONCLUSIONS
Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM types. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients when compared to conventional treatment. Future research, especially in the form of randomized controlled trials, is needed to further investigate the efficacy of various ADMs in the treatment of capsular contracture.
Topics: Humans; Breast Implantation; Acellular Dermis; Mammaplasty; Breast Implants; Contracture; Implant Capsular Contracture; Retrospective Studies
PubMed: 37595294
DOI: 10.1093/asj/sjad265 -
Oral Surgery, Oral Medicine, Oral... Jul 2022The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy.
STUDY DESIGN
We performed a systematic review and meta-analysis of existing literature comparing rates of FS with and without ADM use.
RESULTS
Eight studies were shortlisted for qualitative study, of which 7 compared rates of FS with and without the use of ADM. A total of 211 patients underwent parotidectomy with the use of ADM. Of these, mean patient age was 44.7 (SD ± 7.2); 89 of 159 were pleomorphic adenoma (55.9%), 29 of 159 with histological diagoses stated were Warthin's tumor (18.2%), and 159 of 211 were other histologic diagnoses (25.7%). Subjective and objective incidence rates for FS were 23 of 211 (10.9%) and 7 of 211 (3.3%), respectively. Patients in whom ADM barriers were used had significantly lower rates of subjective and objective FS (relative risk = 0.22; 95% confidence interval, 0.09-0.57; P = .002; and relative risk = 0.07; 95% confidence interval, 0.07-0.33; P < .001), respectively, compared to patients with no ADM.
CONCLUSION
The use of ADM was associated with lower FS rates compared to no ADM and should be considered in routine use to prevent this condition.
Topics: Acellular Dermis; Adenoma, Pleomorphic; Humans; Sweating, Gustatory
PubMed: 35431179
DOI: 10.1016/j.oooo.2021.12.123