The Use of Tumor Prostheses for Primary or Revision Reverse Total Shoulder Arthroplasty With Proximal Humeral Bone Loss

Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS ( P = .03) and ASES score ( P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.

Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

Biomaterials – Novel Advances in Nasal Medical Implants, 3D Printing Applications

The scope and applications of biomaterials have spread out throughout a broad spectrum. Particularly in pharmacy, biomaterials are an attractive choice because they can be modified to decrease toxicity, increase the targeting ability among many other aspects of drug delivery. Extensive studies have led to the development of many metal-based, ceramic, biocompatible and biodegradable biomaterials for medical purposes among many others. The utilization of 3D printing in this discipline is a very novel research subject with infinite potential. Personalized and customized nasal implants are a great option to increase patient compliance and 3D printed accurate anatomical structures are rendered to be effective tools of learning. One of the disadvantages of biomaterial-based implants is the formation of a thick fibrous capsule formation around the implant, others being breakage, soft tissue loss and so on. Regulatory aspects are less explored for nasal implants. 3D printing is a unique technique that allows for a high degree of customisation in pharmacy, dentistry and in designing of medical devices. Current research in 3D printing indicates towards reproducing an organ in the form of a chip; paving the way for more studies and opportunities to perfecting the existing technique.

Intravascular Shunt in Management of Limb Trauma- A Review

Vascular injuries to the upper or lower limb in the context of significant soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Complex extremity vascular injuries in which acute arterial insufficiency combined with severe or prolonged shocks are unacceptable because warm, warm, skeletal muscle time is often exceeded before adequate revascularization, and are associated with extended ischemia periods or fractures or soft tissue wounds. Revascularizing the limb is essential for the success of the limb rescue. Selective intravascular temporary shunting hence allows better overall care of the patient and can therefore be predicted to increase both limb rescue and patient survival rates. The aim of this article was to review and summarize results of previous literature regarding effectiveness on intravascular shunting as management of limb trauma as well as reviewing its potential complications.

A STUDY ON DIFFERENT SURGICAL OPTIONS OF LOWER THIRD LEG DEFECTS AND ITS OUTCOME

Background: The bones of the lower third are vulnerable to injury. Due to the paucity of soft tissues around them, the fractures that occur are often open. Most muscles become tendons at that level and in the case of soft tissue loss, skin graft may not sufce and flap cover becomes mandatory. Conventional teaching recommends gastrocnemius muscle and myocutaneous aps and fasciocutaneous aps for the upper third leg defects, soleus aps for the middle third defects and free aps for the lower third defects. Aim: Different surgical options in management of lower third leg defects. Material And Method: The study was conducted from JANUARY 2018 to December 2019, in the Department of Plastic & Reconstructive Surgery Institute of Post Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, KOLKATA. Result: 70 patients admitted to the Department of Plastic & Reconstructive Surgery and referred patients from Department of General Surgery & Orthopaedic Surgery, IPGME&R and SSKM Hospital, KOLKATA. Association of FLAP LOSS with Pedicled ap was statistically signicant (p=0.0259). We found that association of DONOR SITE MORBIDITYwith Pedicled ap was not statistically signicant (p=0.7679). Conclusion: We consider that perforator propeller aps are ideal in reconstructing small-medium defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor-site morbidity.

Injectable Soft Tissue Nano/Micro Fillers for Facial Reconstruction

Soft Tissue augmentation is a way to restore lost tissue and also a way to reshape confidence for patients who suffer from soft tissue loss. Materials that can realize such a function are called soft tissue fillers. Among the large number of fillers, injectable fillers have attracted widespread attention in facial cosmetic fields due to their convenience and competitive performance. Meanwhile, there is a huge demand for better injectable soft tissue fillers in medical cosmetology market. This review introduces several fillers which were once used in clinical or are now still in use. Furthermore, we update recent improvements and progress on injectable filling materials hoping to contribute to its further developments.

Retrospective Study of 20 Patients that has Treated with Pedicled Groin Flap in Reconstruction in Hand Injuries

Pedicled groin flap has long been playing an important role in reconstructive hand surgery. This flap is a reliable method for closing the defects of the soft tissue loss of the hand and is used in many clinical conditions. This study aims to evaluate the epidemiology and geographic aspects of the patients that required the treatment with pedicled groin flap and to assess the outcomes achieved by the Children’s Surgical Centre to help guide the future practice. We studied of 20 patient that has treated with pedicled groin flap reconstruction of the hand injuries between 2009 and 2019 at the Children’s Surgical Centre, Kien Klerng, Phnom Penh, Cambodia. In this study pedicled groin flap was used in 20 patients aged between 7 to 56 years, with a mean of 31 years or 40 % of all patients. The sex ratio M/F was 1.5 which was 12 male patients (60 %) and 08 female patients (40 %). The main cause of patient hand defects was from contracture related to burn sequelae which is 70 %.

Prosthodontic Perspectives in Mucormycosis: A Review

Rhino-cerebral mucormycosis, a fateful fungal infection which was commonly known to affect the immunocompromised patients, is now thriving in conjunction with Corona virus disease 2019 (COVID-19). Early diagnosis and aggressive medical and surgical intervention are the key factors to extricate the patients. However, this leads to abundant hard and soft tissue loss, leaving behind a huge orofacial defect, along with certain morbidities and psychological trauma, necessitating surgical and prosthodontic rehabilitation. The present paper reviews on role of prosthodontist in various stages of treatment for mucormycosis patients. It also summarizes several treatment modalities including recent trends to rehabilitate the defect and restore the patients’ quality of life.

Early Implant Placement with Delayed Loading in Anterior Aesthetic Zone - A Case Report

To prevent the sequelae of hard and soft tissue loss after tooth extraction, future need of bone augmentation procedures and utilisation of benefits during early stages of tissue healing, early implant promises to be an armoury for dental implantologists to perfectly simulate the natural dentition in anterior aesthetic areas. Here, a case of 30 years old male with a missing #11 (according to two-digit numbering system) planned for early implant placement and immediate temporisation with delayed loading is presented.