Design & Development of a Trans Tibial Socket Stabilized by Alternating Areas of Tissue Compression and Release - A Case Study

The socket is the most important aspect of the artificial limb, constituting the critical interface between the amputee’s stump and prosthesis. The design and fitting of the socket is also the most difficult procedure due to the uniqueness of each amputee’s stump. An uncomfortable socket fit is the most common complaint from lower limb amputees with surveys revealing that amputees believe comfort are the most important aspects of the prosthesis and over half of all wearers are in moderate to severe pain for most of the time whilst wearing the prosthesis. Kristinsson argued that a transtibial socket can be designed to transfer loads primarily to limited areas of the limb such as the patella tendon and the medial flare, which in most cases found both ineffective and uncomfortable. There were inconsistencies in producing satisfactory PTB sockets because of inadequate training of prosthetist in the PTB technique. However, the TSB silicon liner socket has problems such as causing excessive perspiration, heating and odor etc. Therefore, a new socket is designed following the principle of alternative pressure and release to overcome the disadvantages and to check the socket with regard to stability, comfort and satisfaction. Method: A single case study of a person 37-year-old, with transtibial amputation population took part in this study and was selected according to the inclusion criteria. The participant was provided patient information sheet and after taking the informed consent, the assessment and fabrication of the new socket were being proceeded, taking the cast on the first day. On the third day the newly designed socket along with prosthesis was provided with an adaptation period of 7 days. After 7 days the patient was called to check the stability with standing, comfort and satisfaction with a prosthetic socket comfort score. Results and Discussion: The present socket is well suitable for transtibial patient in weight bearing position. It fits well to the contour of the adult patient. The socket was adjusted manually during rectification phase providing respective pressure in areas required. Conclusion: The developed socket had a great effect on gait pattern of transtibial amputee. This socket provides adjustment for pressure, anterior, posterior, medial and lateral of the stump. It also creates surface for the placement of bony prominences. As it is a complex casting procedure, proper care should be taken to fabricate the casting of socket with minimal error. Further, innovative inventions will be required to refine more products and extensive study has to be carried out on the existing mode. Key words: transtibial amputation, transtibial socket, tissue compression and release.

SANOGENETIC AND PHARMACOLOGICAL EFFECTS OF LOCAL APPLICATION OF HYALURONIC ACID IN EXPERIMENTAL SOFT TISSUE COMPRESSION TRAUMA

Regional activation of cellular repair systems, including local application of hyaluronic acid, is a promising direction for the sanogenesis of muscle injuries. Purpose: to identify the sanogenetic and pharmacological effects of local application of hyaluronic acid in experimental soft tissue compression trauma. Compression injury was simulated by mechanical compression of the right pelvic limb of a rat at the level of the lower leg for 7 hours with a pressure force of 10-12 kg/cm2. Further, the animals were divided into 2 groups: 3 hours after decompression, animals in the main group were injected with 3.5% hyaluronic acid (the drug «Hyalift 3.5») by fan-pricking with a sterile disposable syringe at 5-6 points to a depth of 0.5-0.8 cm in a volume of up to 0.1 ml at each point; rats in the control group were given a similar method and an equivalent volume of 0.9% sodium chloride solution. The level of myoglobin in the blood, microcirculation, histomorphological and immuno- histochemical characteristics of tissues in the compression area were studied. A comprehensive analysis of the results of the study allowed us to establish that early local administration of 3.5% hyaluronic acid to the area of compression damage of soft tissues (3 hours after decompression) has a muscle-protecting effect, activates the repair system of damaged skeletal muscles. It is concluded that the sanogenetic effect of hyaluronic acid is mediated by the mecha- nisms of its pharmacological action: activation of angiogenesis, improvement of in situ efficiency of microcirculation and metabolism, reduction of the severity of primary and secondary necrosis and about traumatic disorders, activation of regeneration of damaged muscle fibers with the formation of muscle tissue. Hyaluronic acid is an active stimulant of reparative processes in the perspective of pharmacotherapy and may be a promising component in the local correction of extensive traumatic injuries.

The Coronary Intravascular Lithotripsy System

Calcified lesions often mean percutaneous intervention results are suboptimal and increase the risk of procedural complications and future adverse events. Available plaque-modifying devices rely on tissue compression or debulking, with the intention of fracturing calcium and facilitating optimal stent deployment. In contrast, coronary intravascular lithotripsy delivers unfocused, circumferential, pulsatile mechanical energy to safely disrupt the calcium within the target lesion. The present review summarises the evidence available so far on this therapy and includes a practical description of the components and function of the Shockwave Intravascular Lithotripsy System (Shockwave Medical).

A microfabricated, 3D-sharpened silicon shuttle for insertion of flexible electrode arrays through dura mater into brain

Electrode arrays for chronic implantation in the brain are a critical technology in both neuroscience and medicine. Recently, flexible, thin-film polymer electrode arrays have shown promise in facilitating stable, single-unit recordings spanning months in rats. While array flexibility enhances integration with neural tissue, it also requires removal of the dura mater, the tough membrane surrounding the brain, and temporary bracing to penetrate the brain parenchyma. Durotomy increases brain swelling, vascular damage, and surgical time. Insertion using a bracing shuttle results in additional vascular damage and brain compression, which increase with device diameter; while a higher-diameter shuttle will have a higher critical load and more likely penetrate dura, it will damage more brain parenchyma and vasculature. One way to penetrate the intact dura and limit tissue compression without increasing shuttle diameter is to reduce the force required for insertion by sharpening the shuttle tip. We describe a novel design and fabrication process to create silicon insertion shuttles that are sharp in three dimensions and can penetrate rat dura, for faster, easier, and less damaging implantation of polymer arrays. Sharpened profiles are obtained by reflowing patterned photoresist, then transferring its sloped profile to silicon with dry etches. We demonstrate that sharpened shuttles can reliably implant polymer probes through dura to yield high quality single unit and local field potential recordings for at least 95 days. On insertion directly through dura, tissue compression is minimal. This is the first demonstration of a rat dural-penetrating array for chronic recording. This device obviates the need for a durotomy, reducing surgical time and risk of damage to the blood-brain barrier. This is an improvement to state-of-the-art flexible polymer electrode arrays that facilitates their implantation, particularly in multi-site recording experiments. This sharpening process can also be integrated into silicon electrode array fabrication.