Giulia Colzani - Academia.edu (original) (raw)

Papers by Giulia Colzani

Research paper thumbnail of Complete Peroneal Nerve Palsy: Functional Reconstruction with Tendon Transfers

Research paper thumbnail of Treatment of infected soft tissue loss

Plastic and Aesthetic Research

Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate... more Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive procedure. Debridement must be radical, and all nonviable or infected tissue should be removed. Strict medical control and multiple procedures can be required when infection recurrence is observed after primary procedure. Secondary healing of STL is usually necessary in these complex conditions. Negative pressure wound therapy (NPWT) is often used as a temporary instrument to reduce oedema and drainage, facilitating the attainment of a clean wound for subsequent reconstruction. According to the type and size of the defect, multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL. A reconstructive ladder approach and case-by-case decision making should always be considered. Due to the unique funct...

Research paper thumbnail of Open release of stiff wrist: a medium to long term case series and literature review

Acta bio-medica : Atenei Parmensis, Sep 26, 2022

Background and aim of the work: The authors reported a personal case series of open release of st... more Background and aim of the work: The authors reported a personal case series of open release of stiff wrists performed after previous internal osteosynthesis of distal radius fractures. Methods: From a series of 16 patients operated by a single surgeon, 12 were evaluated at a mean 7.1 years follow-up (range 2.25 to 19 years), while 4 were lost at follow-up. The ROM in flexion-extension achieved at the final control was measured with a goniometer and compared to that recorded before surgery. The PRWHE questionnaire was administred at the last follow-up. Results: The mean flexion improved from 25.5° to 42.3° and the extension from 15.75° to 43°. The mean PRWHE value was 32.9. Conclusions: Although arthroscopic release is increasingly used in clinical practice for its minimal invasinevess and warranty of fast recovery, open arthrolysis in post-traumatic stiff wrists appears to be an effective procedure, adaptable to all types of stiffness, that lets get good long lasting functional results.

Research paper thumbnail of The Era of Nerve Transfers in Tetraplegic Patients: Our Multidisciplinary Experience

Biomedical Journal of Scientific & Technical Research, 2021

Research paper thumbnail of Upper Limb Trauma

Textbook of Plastic and Reconstructive Surgery, 2022

Research paper thumbnail of Complete Peroneal Nerve Palsy: Functional Reconstruction with Tendon Transfers

Clinical Scenarios in Reconstructive Microsurgery, 2022

Research paper thumbnail of Sarcopenia in distal radius fractures: systematic review of the literature and current findings

European Journal of Orthopaedic Surgery & Traumatology, 2020

Introduction Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, str... more Introduction Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, strength and physical ability. Although proximal femur fractures are one of the major burdens affecting the ageing population, distal radius fractures are equally important for frequency, clinical and social consequences. The aim of this study is to evaluate the incidence of sarcopenia in distal radius fractures and clinical implications in functional recovery. Materials and methods Scopus and PubMed search was performed to find relationship between sarcopenia and distal radius fractures. Literature search was performed between 2009 and 2019 including clinical trials and clinical studies related to "sarcopenia and distal radius fracture" and "sarcopenia and wrist fracture". After identification, studies were screened and analysed through the Oxford Level of Evidence. Results According to the inclusion and exclusion criteria, five articles were included. Four articles analysed the incidence of sarcopenia and its role as a risk factor in patients with distal radial fractures, while one article focused on sarcopenia and clinical results of surgical treatment of distal radius fractures. Incidence of sarcopenia in patients older than 50 years with distal radius fracture varied between 29.7% and 31.7%. Patients with distal radial fractures did not show a significant inferior muscle mass than control group in examined population. Functional results of surgery were significantly inferior in sarcopenic patients than control group (no sarcopenia). Conclusions About 30% of patients older than 50 years with distal radius fracture suffered by sarcopenia; sarcopenic patients surgically treated had worse clinical results than no sarcopenic patients. Further studies with larger samples are needed to confirm these preliminary results.

Research paper thumbnail of Long-term results of Zweymüller SLL femoral stem in revision hip arthroplasty for stage II and IIIA femoral bone defect: a 9–15-year follow-up study

MUSCULOSKELETAL SURGERY, 2019

Background Loosening of femoral stem can be associated with a wide spectrum of bone loss that rep... more Background Loosening of femoral stem can be associated with a wide spectrum of bone loss that represents the most important factor for choosing the most appropriate revision implant. Positive outcomes in femoral revision were already observed with Zweymüller Alloclassic ® SLL stem in short-and medium-term follow-up. The aim of the study is to analyse the clinical results of 31 patients who underwent prosthetic revision for aseptic loosening of femoral component with Zweymüller femoral stem and long follow-up. Methods The series included 10 men and 21 women with a mean age of 66.24 years at the time of revision surgery and a mean follow-up of 12.25 years. Clinical and radiological evaluation was performed at 2 months, 6 months and yearly, using Harris Hip Score (HHS) and Engh's criteria and Brooker classification for heterotopic ossifications. Results At the last follow-up, the survival of the stem was observed in all patients (32 hips). The mean HHS was 77.83 ± 20.90. Clinical results were stated as excellent in 14 cases, good in 5 cases, fair in 4 cases and poor in 9 cases. Radiographic stability with fixation by bone ingrowth was observed in 15 cases and with fibrous ingrowth in 17 cases. Heterotopic ossifications grade III was observed in 4 cases and grade II in 3 cases. Conclusions Zweymüller Alloclassic ® SLL stem showed excellent or good results in about 59% of revision surgery for aseptic loosening. The survival rate of the stem at 9-15 years of follow-up was satisfactory.

Research paper thumbnail of A mini-invasive tenolysis of the flexor tendons following hand fractures: case series

MUSCULOSKELETAL SURGERY, 2017

Research paper thumbnail of Clinical Applications of End-to-Side Neurorrhaphy: An Update

BioMed Research International, 2014

End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage ... more End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.

Research paper thumbnail of A new sign allowing diagnosis in the pathologies of the extensor tendons of the hand

Research paper thumbnail of Principles of Cortical Plasticity in Peripheral Nerve Surgery

Surgical technology international, 2020

Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to... more Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to change in response to internal and external stimuli. While these modifications occur throughout normal brain development, interestingly, they are also elicited after peripheral nerve injury and surgery. This article provides an overview of the principle mechanisms of synaptic, neuronal, cortical and subcortical neuroplasticity, with special attention to cortical and subcortical modifications-as suggested by modern neuroimaging techniques-after peripheral nerve surgery. The main nerve transfer techniques for the superior extremities and their effect on cortical plasticity are also described.

Research paper thumbnail of Metallosis in Sequelae of Prosthetic Revision for Ceramic Components Fracture: A Case Report with Clinical Presentation Mimicking Periprosthetic Hip Infection

Joints, 2019

Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decad... more Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.

Research paper thumbnail of Megaprostheses in the Revision of Infected Total Hip Arthroplasty. Clinical Series and Literature Review

Bulletin of the Hospital for Joint Disease, 2015

PURPOSE The management of severe femoral bone loss associated with hip infection is a major probl... more PURPOSE The management of severe femoral bone loss associated with hip infection is a major problem in joint replacement surgery. Femoral megaprostheses have been rarely reported in reconstructive procedure for this complex condition. The aim of the study was to evaluate clinical results observed after such uncommon reconstruction in our case series and in a similar group of patients extracted by literature review. METHODS We evaluated clinical outcomes and eradication of sepsis in five patients who underwent femoral revision with modular femoral resection stems at our institution, and we reviewed the literature about this topic. In our case series, the femoral bone loss was grade III-B in three cases and grade IV in two cases according to the Paprosky classification. One patient was operated with one-stage revision, and four patients were operated with two-stage revision. The mean age was 72 years (range: 60 to 81 years), and the mean time of follow-up was 62 months (range: 36 to 8...

Research paper thumbnail of Challenges in restoration of extensor tendons function at the hand

Acta Bio Medica : Atenei Parmensis, 2021

Introduction: The authors discuss challenges in extensor function restoration at the finger level... more Introduction: The authors discuss challenges in extensor function restoration at the finger level following distal posterior interosseous or tendon complex injuries, according to the typologies of lesions or the specific patient requirements. Materials: The authors report on two cases describing challenging resolutions. One patient with EDC lag from zone 6B to 8 requiring FCU prolonged with cadaveric grafts. One young patient with distal posterior interosseous lesion requiring selective tendon transfers to EPL and EIP to restore selective and autonomous index extension. Results: In both cases the main goals were obtained, achieving high index of patient satisfaction and excellent outcomes with the restoration of the extension of the fingers. Conclusions: In distal posterior interosseous nerve lesion, high demanding patients may require selective function to restore fine motor skills, such as autonomous index extension. In extensor tendons loss of substance from zone 6 to 8, involvin...

Research paper thumbnail of Surgery and CoVid-19 pandemic's effects on the fragile psychosocial background in tetraplegic patients: psychological considerations

Research paper thumbnail of Soft tissue coverage of the upper limb: A flap reconstruction overview

Annals of Medicine and Surgery

Research paper thumbnail of Digital Replantations: Comparison Veins Anastomoses first versus Arteries Anastomoses first

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

Purpose This retrospective study analyses the effect performing veins anastomoses before arteries... more Purpose This retrospective study analyses the effect performing veins anastomoses before arteries anastomoses in digital replantation. Patients and methods 38 adult patients with replantation of 12 thumbs and 39 fingers, in whom the veins anastomoses were performed prior to the arteries anastomoses, were compared with 29 patients with replantation of 9 thumbs and 30 fingers, in whom the arteries anastomoses were done first, with respect to the survival rate, total active motion, grip strength, and duration of the replantation. Results There was no significant difference between the two groups with respect to the survival rates, total active motion, and grip strength, while the duration of the replantation was significantly shorter in patients, in whom the veins anastomoses were performed prior to the arteries anastomoses (2 hours and 50 minutes versus 3 hours and 42 minutes; p

Research paper thumbnail of Letter to the Editor Regarding “Opinion Piece: Microsurgery in COVID-19–Positive Patients”

Research paper thumbnail of Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold

HAND

Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioa... more Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.

Research paper thumbnail of Complete Peroneal Nerve Palsy: Functional Reconstruction with Tendon Transfers

Research paper thumbnail of Treatment of infected soft tissue loss

Plastic and Aesthetic Research

Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate... more Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive procedure. Debridement must be radical, and all nonviable or infected tissue should be removed. Strict medical control and multiple procedures can be required when infection recurrence is observed after primary procedure. Secondary healing of STL is usually necessary in these complex conditions. Negative pressure wound therapy (NPWT) is often used as a temporary instrument to reduce oedema and drainage, facilitating the attainment of a clean wound for subsequent reconstruction. According to the type and size of the defect, multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL. A reconstructive ladder approach and case-by-case decision making should always be considered. Due to the unique funct...

Research paper thumbnail of Open release of stiff wrist: a medium to long term case series and literature review

Acta bio-medica : Atenei Parmensis, Sep 26, 2022

Background and aim of the work: The authors reported a personal case series of open release of st... more Background and aim of the work: The authors reported a personal case series of open release of stiff wrists performed after previous internal osteosynthesis of distal radius fractures. Methods: From a series of 16 patients operated by a single surgeon, 12 were evaluated at a mean 7.1 years follow-up (range 2.25 to 19 years), while 4 were lost at follow-up. The ROM in flexion-extension achieved at the final control was measured with a goniometer and compared to that recorded before surgery. The PRWHE questionnaire was administred at the last follow-up. Results: The mean flexion improved from 25.5° to 42.3° and the extension from 15.75° to 43°. The mean PRWHE value was 32.9. Conclusions: Although arthroscopic release is increasingly used in clinical practice for its minimal invasinevess and warranty of fast recovery, open arthrolysis in post-traumatic stiff wrists appears to be an effective procedure, adaptable to all types of stiffness, that lets get good long lasting functional results.

Research paper thumbnail of The Era of Nerve Transfers in Tetraplegic Patients: Our Multidisciplinary Experience

Biomedical Journal of Scientific & Technical Research, 2021

Research paper thumbnail of Upper Limb Trauma

Textbook of Plastic and Reconstructive Surgery, 2022

Research paper thumbnail of Complete Peroneal Nerve Palsy: Functional Reconstruction with Tendon Transfers

Clinical Scenarios in Reconstructive Microsurgery, 2022

Research paper thumbnail of Sarcopenia in distal radius fractures: systematic review of the literature and current findings

European Journal of Orthopaedic Surgery & Traumatology, 2020

Introduction Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, str... more Introduction Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, strength and physical ability. Although proximal femur fractures are one of the major burdens affecting the ageing population, distal radius fractures are equally important for frequency, clinical and social consequences. The aim of this study is to evaluate the incidence of sarcopenia in distal radius fractures and clinical implications in functional recovery. Materials and methods Scopus and PubMed search was performed to find relationship between sarcopenia and distal radius fractures. Literature search was performed between 2009 and 2019 including clinical trials and clinical studies related to "sarcopenia and distal radius fracture" and "sarcopenia and wrist fracture". After identification, studies were screened and analysed through the Oxford Level of Evidence. Results According to the inclusion and exclusion criteria, five articles were included. Four articles analysed the incidence of sarcopenia and its role as a risk factor in patients with distal radial fractures, while one article focused on sarcopenia and clinical results of surgical treatment of distal radius fractures. Incidence of sarcopenia in patients older than 50 years with distal radius fracture varied between 29.7% and 31.7%. Patients with distal radial fractures did not show a significant inferior muscle mass than control group in examined population. Functional results of surgery were significantly inferior in sarcopenic patients than control group (no sarcopenia). Conclusions About 30% of patients older than 50 years with distal radius fracture suffered by sarcopenia; sarcopenic patients surgically treated had worse clinical results than no sarcopenic patients. Further studies with larger samples are needed to confirm these preliminary results.

Research paper thumbnail of Long-term results of Zweymüller SLL femoral stem in revision hip arthroplasty for stage II and IIIA femoral bone defect: a 9–15-year follow-up study

MUSCULOSKELETAL SURGERY, 2019

Background Loosening of femoral stem can be associated with a wide spectrum of bone loss that rep... more Background Loosening of femoral stem can be associated with a wide spectrum of bone loss that represents the most important factor for choosing the most appropriate revision implant. Positive outcomes in femoral revision were already observed with Zweymüller Alloclassic ® SLL stem in short-and medium-term follow-up. The aim of the study is to analyse the clinical results of 31 patients who underwent prosthetic revision for aseptic loosening of femoral component with Zweymüller femoral stem and long follow-up. Methods The series included 10 men and 21 women with a mean age of 66.24 years at the time of revision surgery and a mean follow-up of 12.25 years. Clinical and radiological evaluation was performed at 2 months, 6 months and yearly, using Harris Hip Score (HHS) and Engh's criteria and Brooker classification for heterotopic ossifications. Results At the last follow-up, the survival of the stem was observed in all patients (32 hips). The mean HHS was 77.83 ± 20.90. Clinical results were stated as excellent in 14 cases, good in 5 cases, fair in 4 cases and poor in 9 cases. Radiographic stability with fixation by bone ingrowth was observed in 15 cases and with fibrous ingrowth in 17 cases. Heterotopic ossifications grade III was observed in 4 cases and grade II in 3 cases. Conclusions Zweymüller Alloclassic ® SLL stem showed excellent or good results in about 59% of revision surgery for aseptic loosening. The survival rate of the stem at 9-15 years of follow-up was satisfactory.

Research paper thumbnail of A mini-invasive tenolysis of the flexor tendons following hand fractures: case series

MUSCULOSKELETAL SURGERY, 2017

Research paper thumbnail of Clinical Applications of End-to-Side Neurorrhaphy: An Update

BioMed Research International, 2014

End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage ... more End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.

Research paper thumbnail of A new sign allowing diagnosis in the pathologies of the extensor tendons of the hand

Research paper thumbnail of Principles of Cortical Plasticity in Peripheral Nerve Surgery

Surgical technology international, 2020

Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to... more Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to change in response to internal and external stimuli. While these modifications occur throughout normal brain development, interestingly, they are also elicited after peripheral nerve injury and surgery. This article provides an overview of the principle mechanisms of synaptic, neuronal, cortical and subcortical neuroplasticity, with special attention to cortical and subcortical modifications-as suggested by modern neuroimaging techniques-after peripheral nerve surgery. The main nerve transfer techniques for the superior extremities and their effect on cortical plasticity are also described.

Research paper thumbnail of Metallosis in Sequelae of Prosthetic Revision for Ceramic Components Fracture: A Case Report with Clinical Presentation Mimicking Periprosthetic Hip Infection

Joints, 2019

Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decad... more Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.

Research paper thumbnail of Megaprostheses in the Revision of Infected Total Hip Arthroplasty. Clinical Series and Literature Review

Bulletin of the Hospital for Joint Disease, 2015

PURPOSE The management of severe femoral bone loss associated with hip infection is a major probl... more PURPOSE The management of severe femoral bone loss associated with hip infection is a major problem in joint replacement surgery. Femoral megaprostheses have been rarely reported in reconstructive procedure for this complex condition. The aim of the study was to evaluate clinical results observed after such uncommon reconstruction in our case series and in a similar group of patients extracted by literature review. METHODS We evaluated clinical outcomes and eradication of sepsis in five patients who underwent femoral revision with modular femoral resection stems at our institution, and we reviewed the literature about this topic. In our case series, the femoral bone loss was grade III-B in three cases and grade IV in two cases according to the Paprosky classification. One patient was operated with one-stage revision, and four patients were operated with two-stage revision. The mean age was 72 years (range: 60 to 81 years), and the mean time of follow-up was 62 months (range: 36 to 8...

Research paper thumbnail of Challenges in restoration of extensor tendons function at the hand

Acta Bio Medica : Atenei Parmensis, 2021

Introduction: The authors discuss challenges in extensor function restoration at the finger level... more Introduction: The authors discuss challenges in extensor function restoration at the finger level following distal posterior interosseous or tendon complex injuries, according to the typologies of lesions or the specific patient requirements. Materials: The authors report on two cases describing challenging resolutions. One patient with EDC lag from zone 6B to 8 requiring FCU prolonged with cadaveric grafts. One young patient with distal posterior interosseous lesion requiring selective tendon transfers to EPL and EIP to restore selective and autonomous index extension. Results: In both cases the main goals were obtained, achieving high index of patient satisfaction and excellent outcomes with the restoration of the extension of the fingers. Conclusions: In distal posterior interosseous nerve lesion, high demanding patients may require selective function to restore fine motor skills, such as autonomous index extension. In extensor tendons loss of substance from zone 6 to 8, involvin...

Research paper thumbnail of Surgery and CoVid-19 pandemic's effects on the fragile psychosocial background in tetraplegic patients: psychological considerations

Research paper thumbnail of Soft tissue coverage of the upper limb: A flap reconstruction overview

Annals of Medicine and Surgery

Research paper thumbnail of Digital Replantations: Comparison Veins Anastomoses first versus Arteries Anastomoses first

Handchirurgie · Mikrochirurgie · Plastische Chirurgie

Purpose This retrospective study analyses the effect performing veins anastomoses before arteries... more Purpose This retrospective study analyses the effect performing veins anastomoses before arteries anastomoses in digital replantation. Patients and methods 38 adult patients with replantation of 12 thumbs and 39 fingers, in whom the veins anastomoses were performed prior to the arteries anastomoses, were compared with 29 patients with replantation of 9 thumbs and 30 fingers, in whom the arteries anastomoses were done first, with respect to the survival rate, total active motion, grip strength, and duration of the replantation. Results There was no significant difference between the two groups with respect to the survival rates, total active motion, and grip strength, while the duration of the replantation was significantly shorter in patients, in whom the veins anastomoses were performed prior to the arteries anastomoses (2 hours and 50 minutes versus 3 hours and 42 minutes; p

Research paper thumbnail of Letter to the Editor Regarding “Opinion Piece: Microsurgery in COVID-19–Positive Patients”

Research paper thumbnail of Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold

HAND

Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioa... more Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.