638 Biodegradable Temporizing Matrix in Combination with Wide Meshed Graft and Autologous Spray Cell Suspension (ASCS) Graft Can be Used for Reconstruction of Extensive Necrotizing Infections: A Case Report

Introduction Background: A necrotizing infection of the left upper extremity underwent extensive debridement with remaining exposed muscle, tendon, and bone. BTM was used to provide an acceptable temporizing matrix in conjunction with wide meshed split thickness skin graft (STSG) 3:1 ratio and ASCS graft for successful reconstruction. This left a functional limb and avoided arm forequarter amputation. Methods Case Presentation: We present a 67 y/o male with necrotizing infection who underwent extensive surgical debridement of skin and subcutaneous tissues of the left hand, forearm, and upper arm. BTM was applied for coverage over muscle, tendon, and bone to salvage his arm and avoid forequarter amputation. Following maturation of the BTM a 3:1 ratio STSG was placed along with application of an ASCS graft. A vacuum assisted closure (VAC) dressing was successfully used to stabilize the grafts. One month post grafting the wound was approximately 94% healed, with good range of motion, and limited but improving function of his arm. Results Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and autologous ASCS grafting. A wound VAC provided a safe and effective dressing over these grafted mediums. Conclusions Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and ASCS epidermal autograft. A wound VAC provided a safe and effective dressing over these grafted mediums.

The effect of closed-incision negative pressure wound therapy on clinical and ultrasonographic seroma formation and wound healing following forequarter amputation in large dogs - a randomized pilot trial

This pilot study aimed at evaluating whether closed-incision negative pressure wound therapy (ciNPWT) has an effect on seroma formation and wound healing following forequarter amputation in dogs above 20 kg. Twelve client-owned dogs weighing more than 20 kg, presented for forequarter amputation, were randomly assigned after surgery into two groups (six ciNPWT and six controls with soft-padded bandage, both bandages applied for three days). A clinical and ultrasonographic control (newly developed scoring system) was performed at bandage removal (three days postoperatively) and ten days, postoperatively. A postoperative seroma was present in 4/6 dogs in the ciNPWT group and in 5/6 dogs in the control group. There were no apparent differences in the ultrasonographic scores or subcutis measurements at three versus ten days, postoperatively. The results of this pilot trial do not support expansion to a larger-scale study evaluating ciNPWT after forequarter amputation in dogs.

Design and development of a novel 3D-printed non-metallic self-locking prosthetic arm for a forequarter amputation

Background: Upper limb, in particular forequarter amputations, require highly customised devices that are often expensive and underutilised. Objectives: The objective of this study was to design and develop a comfortable 3D-printed cosmetic forequarter prosthetic device, which was lightweight, cool to wear, had an elbow that could lock, matched the appearance of the contralateral arm and was completely free of metal for a specific user’s needs. Study Design: Device design. Technique: An iterative user-centred design approach was used for digitising, designing and developing a functional 3D-printed prosthetic arm for an acquired forequarter amputation, while optimising the fit and function after each prototype. Results: The cost of the final arm was 20% less expensive than a traditionally-made forequarter prostheses in Singapore. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 survey was administered, with results indicating that the 3D-printed arm was preferred due to its overall effectiveness, accurate size, ease of use and suspension. However, durability had a lower score, and the weight of the arm was 100 g heavier than the user’s current prosthesis. The technique described resulted in a precise fitting and shaped forequarter prosthesis for the user. Using the user’s feedback in the iterations of the design resulted in improved QUEST survey results indicating the device was effective, easy to use, perceived as lighter and more secure than the user’s traditionally-made device. Conclusion: A fully customised cosmetic forequarter prosthesis was designed and developed using digital scanning, computer-aided design modelling and 3D printing for a specific user. These technologies enable new avenues for highly complex prosthetic design innovations.