Anterior Defects Research Articles

Effectiveness of Virtual Surgical Planning and Three-Dimensional Anatomical Models in Radiological Reconstruction of Center of Rotation and Pelvic Brim in Patients with Anterior Column Defects Requiring Revision Hip Arthroplasty

Background: The aim of this study was to show that virtual surgical planning (VSP) and printed anatomical models support the reconstruction of the center of rotation (COR) and pelvic BRIM during revision hip surgery using a dual-mobility revision cup system in patients with anterior pelvic column damage and soft tissue envelope deficiency. Methods: Patients with anterior pelvic column damage and soft tissue envelope deficiency underwent revision hip arthroplasty. Virtual planning included assessment of bone segmentation, positioning of the cementless revision cup while maintaining the COR, and the assumed inclination and anteversion angles. Results: The diameter of the planned revision cups was 65.5 ± 2.1 mm, and the diameter of the revision cups used was 65.3 ± 2.1 mm. The difference in COR position in the horizontal axis was 7.8 ± 9.3 mm, in the vertical axis was 4.3 ± 5.9 mm, and in the axial plane was 1.6 ± 3.3 mm. The differences in inclination angle and in the anteversion angle were 12.4° and 8.7°, respectively. Conclusions: The use of VSP and 3D models supports the process of performing RHA surgery in patients with damage to the anterior pelvic column and soft tissue envelope deficiency.

Selecting Root Coverage Techniques for Autogenous Soft Tissue Grafts at Isolated and Multiple-Adjacent Mandibular Anterior Recession Defects

It is widely acknowledged that multiple anatomic and technical factors hinder successful root coverage in the mandibular anterior region. Nevertheless, the contemporary periodontal plastic surgeon is presented with a panoply of options when deciding upon the most appropriate technique to apply in a particular clinical scenario. Although many techniques are applicable at a variety of defect types, several are particularly well suited for specific situations commonly encountered in the mandibular anterior. The purpose of this report is to describe rationale for preferred autogenous soft tissue grafting techniques at isolated mandibular incisor sites, isolated mandibular canine sites, and multiple-adjacent recession defects in the mandibular anterior. Four cases are presented to exemplify the recommended procedures.

Anterior Glenohumeral Instability

➢ Anterior glenohumeral instability is a complex orthopaedic problem that requires a detailed history, a thorough physical examination, and a meticulous review of advanced imaging in order to make individualized treatment decisions and optimize patient outcomes.➢ Nonoperative management of primary instability events can be considered in low-demand patients, including elderly individuals or younger, recreational athletes not participating in high-risk activities, and select in-season athletes. Recurrence can result in increased severity of soft-tissue and osseous damage, further increasing the complexity of subsequent surgical management.➢ Surgical stabilization following primary anterior instability is recommended in young athletes who have additional risk factors for failure, including participation in high-risk sports, hyperlaxity, and presence of bipolar bone loss, defined as the presence of both glenoid (anteroinferior glenoid) and humeral head (Hill-Sachs deformity) bone loss.➢ Several surgical treatment options exist, including arthroscopic Bankart repair with or without additional procedures such as remplissage, open Bankart repair, and osseous restoration procedures, including the Latarjet procedure.➢ Favorable results can be expected following arthroscopic Bankart repair with minimal (<13.5%) bone loss and on-track Hill-Sachs lesions following a primary instability event. However, adjunct procedures such as remplissage should be performed for off-track lesions and should be considered in the setting of subcritical glenoid bone loss, select high-risk patients, and near-track lesions.➢ Bone-grafting of anterior glenoid defects, including autograft and allograft options, should be considered in cases with >20% glenoid bone loss.

Anterior Skull Base Reconstruction Using a Vascularized Pericranial Flap: A Promising Alternative in Sinonasal Malignancies

Abstract Background As the scope of endoscopic techniques continues to evolve in the treatment of advanced sinonasal malignancies, the primary challenge is the reconstruction of the resulting anterior skull base dural defect. Objective This study aimed to assess the efficacy of vascularized pericranial flap reconstruction in addressing anterior skull base defects in sinonasal malignancies, particularly when alternative reconstructive methods, such as nasoseptal flaps, are not viable. Methods We conducted a retrospective review of nine patients who underwent endoscopic resection of sinonasal malignancy followed by vascularized pericranial flap. Our analysis aimed to evaluate the surgical methods utilized, identify any complications that occurred, and assess the postoperative results of the patients. Results Excluding the singular instance of tension pneumocephalus that emerged during the immediate postoperative period, necessitating surgical intervention, our clinical experience was devoid of any complications, with a median follow-up duration of 18 months. It is worth noting that no cases of cerebrospinal fluid leaks or meningitis were reported. Moreover, the follow-up check endoscopy verified the successful integration of the flap and its efficacious coverage of the resection site. Conclusion This study underscores the benefits of using vascularized pericranial flaps as an alternative solution for anterior skull base reconstruction in sinonasal malignancies. The availability of the pericranial flap in the local region, along with its robust blood supply, and the positive outcomes observed in this preliminary series collectively indicate its potential as an integral component of multi-layered reconstruction techniques for addressing anterior skull base defects.

Rehabilitation of a Severe Anterior Ridge Defect with a Fixed-Removable Prosthesis

Significant anterior ridge abnormalities might be difficult to restore with prosthesis. To attain good speech and aesthetics necessitate not only the restoration of the missing teeth but also the closure of the problematic region. One recommended treatment option for individuals with substantial ridge abnormalities is the Andrews bridge which is a fixed-removable prosthesis. The prosthesis correctly replaces the missing teeth and corrects the ridge defect area and restore speech and appearance. A 35-year-old female patient reported with the principal complaint of spacing in her lower front teeth and difficulty in phonetics and poor appearance. On clinical examination spacing was seen in the maxillary central incisors along with pro-clination and 31,32,33,41,42,43 teeth were missing and the edentulous defect area was coming under Seibert's Class III category. Rehabilitation of such defect with an Andrews bridge described in this case report, which used natural teeth as abutments for its permanent component and a detachable superstructure.

Biomechanical evaluation of six zygomatic implants versus four zygomatic implants combined with dental implants in the treatment of different maxillary defects

BackgroundThis study aims to compare the biomechanics of six zygomatic implants (ZIs) and dental implants (DIs) combined with four ZIs with different maxilla defects.MethodsThree-dimensional constructs of the ZIs, DIs human skulls, and maxillary prostheses were created using SolidWorks Software (Version 2015, Dassault Systems SolidWorks Corporation, Waltham, MA, USA). Eight finite element models of the skull with four different alveolar defect types (0–4) were constructed. Type 0: No defect; Type 1: Bilateral posterior defects; Type 2: Right posterior defect; Type 3: Anterior and left posterior defects; Type 4: Bilateral posterior and anterior defects. In two models with the same defect type (for defect types 0–2), six ZIs or two DIs combined with four ZIs were inserted into the maxilla. Six ZIs were inserted in the maxilla models with defect types 3 and 4. Vertical (150 N) and masseteric (300 N) loads were simulated on the prosthesis. The maximum Von Mises stress in the implants/surrounding bone and bone deformation were evaluated.ResultsThe maximum Von Mises stresses in bone/implant were found highest in the defect type 2 model with four ZIs combined with two DIs. The lowest maximum Von Mises stress for bone was detected in the model with defect type 0 and with six ZIs.ConclusionAmong the four types of defects, the posterior unilateral defect caused the highest stress value.

Incidence of Congenital Posterior Arch Defects of the Atlas in Chinese Population

To study the incidence of congenital posterior arch defects of the atlas and in combination with other congenital variations in the Chinese population. 1405 images of cervical three-dimensional computed tomography (3D CT) and 1284 images of head and cervical three-dimensional computed tomography angiography (3D CTA) were retrospectively reviewed, including images of 1539 males and 1150 females. These images of cervical 3D CT and head and cervical 3D CTA were obtained in the Department of Radiology of two hospitals, Second and Third People's Hospital of Jingzhou, China, from January 2020 to October 2023. And congenital posterior arch defects of the atlas were classified according to the criteria of Currarino et al. Congenital posterior arch defects of the atlas combined with other congenital variations including occipitalization of the atlas, the ponticulus posticus variation of the vertebral artery groove of the atlas, cervical fusion, and the transversal foramen of the atlas variant were also observed. A total of 2689 subjects were included in this study. The overall prevalence of congenital posterior arch defects of the atlas was 0.74% (20/2689). There was no statistically significant difference in incidence between males (0.78%,12/1539) and females (0.70%,8/1150) (P >0.05). Among all posterior defects, type A and B defects were found in 0.6% (16/2689) and 0.15% (4/2689) cases, respectively. There were no type C, D, and E defects and no anterior arch defects. But in 20 cases of congenital posterior arch defects of atlas, 40%(8/20) combined with other congenital variations including occipitalization of atlas in 4 type A cases, bilateral complete ponticus posticus variation of atlas vertebral groove in one type A case, C2-3 fusion in one type A case, coexistence of unilateral complete ponticulus posticus variation of the vertebral artery groove of the atlas and unilateral unclosed transverse foramen in one type B case, and coexistence of unilateral unclosed transverse foramen in one type A case. The incidence of congenital posterior arch defects of the atlas was low in Chinese population. There was no difference between males and females. Type A and B were the two major defects in Chinese population, and the prevalence of type A and B combined with other congenital cervical variations were higher than those of type C, D, and E.

Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation.

We describe in detail a novel surgical technique for repairing donor anterior left atrial wall defect in vivo by rotating the posterior atrial flap during lung transplantation. This method can safely and effectively address the most common type of donor left atrial cuff defect: the anterior wall defect, with the intact posterior wall, typically retained when the donor heart is also used. During atrial cuff anastomosis in lung transplantation, the excess donor posterior atrial wall is trimmed into an atrial flap. After the posterior wall anastomosis is completed, the atrial flap is rotated 180° and used as a patch for anterior wall reconstruction anastomosis. After restoring blood flow, the flow rate of the pulmonary vein is normal and smooth as confirmed by transesophageal echocardiography. Compared with the traditional patch reconstruction method, the new method effectively reduces the atrial cuff anastomosis time. Our results showed no significant difference in pulmonary vein obstruction after reconstruction. Pulmonary artery systolic blood pressure was significantly lower and pulmonary function improved postoperatively in all groups, with no significant differences among the groups. The new technique provides a feasible strategy for the reconstruction of left atrial cuff defects and can improve the effective utilization rate of donor lungs.

Superiorly Based Preauricular Tunneled Perforator Flap for Anterior Auricular Surface Defects

Superiorly Based Preauricular Tunneled Perforator Flap for Anterior Auricular Surface Defects

Immune checkpoint inhibitor induced hypophysitis: a specific disease of corticotrophs?

The aim of this study was to define functional and anatomical pituitary disease at the time of presentation following immune checkpoint inhibitor (ICI) therapy and to describe any changes in pituitary function over time. We conducted a retrospective observational audit of patients on ICI therapy at our centre between January 2013 and September 2023. We reviewed all patients on ICI therapy under the care of the oncology department at University Hospital Plymouth, a 1000-bedded hospital serving a population of 500,000 people. From this group, we identified all individuals referred to the endocrinology department with a suspected diagnosis of adrenal insufficiency. Patients were established on adrenal steroid replacement and subsequently underwent formal pituitary testing. People were included if they had pituitary disease, as evidenced by low ACTH, other pituitary dysfunction and/or abnormalities on pituitary imaging. Nine hundred and fifty-four patients received ICI therapy during the study period, and 37 (a prevalence of 3.9%) developed hypothalamic-pituitary-adrenal axis dysfunction. Their mean age was 65 years, and 70% were male. About 86.5% of the total patients affected were treated for metastatic malignancies. Ten of the 37 patients died during follow-up as a direct consequence or complication of their primary cancer diagnosis. The median interval for the onset of symptoms was 4 months. Following repeated testing, there was no recovery in cortisol or ACTH levels for any individual. Other permanent anterior pituitary hormone defects were unusual. Hypophysitis associated with immunotherapy appears to specifically target the corticotrophs, with no evidence of recovery over time. There was a specific abnormality seen in MRI scans of 7 of 27 patients who had scans, which appeared to be a particular feature of immune-mediated hypophysitis. These were confined to the anterior aspect of the pituitary gland, appearing as striations, and were not visible on any of the scans performed more than 3 months after the likely onset of the disease. These data show that immune-related hypophysitis is a common complication of immune checkpoint inhibitor therapy. This may result in an imaging abnormality within the areas of the pituitary that are richest in corticotrophs. The endocrine consequence of this is a permanent defect in ACTH and, therefore, cortisol production.

Complete Pentalogy Of Cantrell: Case Report And Review Of Literature

Introduction: Pentalogy of Cantrell (POC) is a rare congenital anomaly with two sub-categories: complete or partial. Complete has all five defects (anterior diaphragmatic defect, ventral abdominal wall defect, pericardial defect, intracardiac anomalies, and lower sternal defect). The first documented case was described by Cantrell et al. in 1958. Both sporadic and genetic causes have been proposed for POC, with a reported incidence of 5 - 10 cases per one million live births and various clinical presentations. The prognosis of POC depends on the severity of the defects and the associated cardiac anomalies. This case report seeks to increase awareness of this condition, emphasize the need for appropriate counselling in our environment, and review the literature on previous reported cases’ outcomes. Case Presentation: A 5-hour-old term female neonate was referred to our Children Emergency Center with multiple defects (ectopia cordis, sternal cleft, omphalocele, and limb abnormalities) with dysmorphic facies. A diagnosis of POC was made, and multidisciplinary management was instituted. The eviscerated heart and epigastric omphalocele were dressed and evaluated for palliative surgical care. However, she developed complications with sepsis and electrolyte derangements and died from multi-organ failure before any surgical intervention could be carried out. Conclusion: Though rare, the Pentalogy of Cantrell in its classical form does occur in our environment. The presence of extracardiac and limb deformities worsens the outcome. Based on poor outcomes, there is a need to emphasize appropriate antenatal and postnatal assessments to provide effective counselling on termination, neonatal palliative care, and surgical repairs as appropriate.

Arthroscopic subscapularis augmentation of the classic Bankart repair leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss.

The long-term failure rate of the arthroscopic Bankart repair may reach unacceptable values, raising the need to augment this classic procedure. Arthroscopic subscapularis augmentation is the tenodesis of the upper part of the subscapularis tendon to the anterior glenoid rim. The aim of the study was to evaluate the mid-term clinical and functional outcomes of patients operated with arthroscopic subscapularis augmentation of the classic Bankart repair due to recurrent anterior shoulder instability. This is a retrospective single-centre case series study with prospectively collected data. All patients suffered from recurrent anterior shoulder instability and had glenoid bone loss less than 13.5% of the inferior glenoid diameter (subcritical glenoid bone loss). Patients with greater anterior glenoid bone defect, engaging Hill-Sachs lesions, multidirectional instability or subscapularis insufficiency were excluded. Postoperatively, all patients were evaluated for recurrence and apprehension. The patient's shoulder range of motion and functional scores were recorded. The final study cohort included 34 patients with a mean age of 29.3 ± 10.2 years. The mean follow-up period was 42.4 ± 10.7 months (range, 24-62 months). Two out of 34 patients (5.8%) experienced a re-dislocation postoperatively, while one additional patient had a subjective feeling of apprehension. External rotation at the last follow-up was lower compared to preoperative values or the healthy side, but only one patient had restrictions in his sporting activities. The functional scores were significantly increased compared to the preoperative values. Twenty-two out of 26 patients (84.6%) returned to the same level of sporting activities, and 30/34 patients (88.2%) were highly satisfied with the results. Arthroscopic subscapularis augmentation of the classic Bankart repair reduces the dislocation recurrence rate and leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss. Level IV.

Promising clinical effect of arthroscopic autologous iliac bone grafting with suture anchor binding fixation for recurrent anterior shoulder instability.

To evaluate the clinical efficacy of arthroscopic autologous iliac bone grafting with suture anchor binding fixation combined with a Bankart repair for recurrent anterior shoulder dislocation with a significant anterior glenoid defect. Patients with recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20% admitted to our department from March 2019 to March 2022 were prospectively enrolled. Arthroscopic autologous iliac bone grafting with suture anchor binding fixation combined with a Bankart repair was performed. Computed tomography (CT) images were captured preoperatively, immediately after surgery, and at 3, 6, and 12 months postoperatively to evaluate the glenoid defect area, graft area, and graft healing. Shoulder function was assessed using the Instability Severity Index, Oxford Shoulder Instability, and Rowe scores recorded preoperatively and at the final follow-up. The shoulder range of motion, shoulder stability test, surgery-related complications, subluxation/dislocation, and revision surgery were also evaluated. A total of 32 patients were included in the study, with an average follow-up time of 18.3 ± 6.3 months, when the graft healing rate was shown to be 100%. The area ratio of the graft to the glenoid was 37.6% ± 10.5% (range, 23.5%-44.1%) determined by an enface-view three-dimensional CT performed immediately after surgery, and 29.2 ± 8.2% (range, 19.6%-38.7%) at 12 months postoperatively. At the final follow-up, the glenoid defect had improved from 28.7 ± 6.4% (range, 20.5%-40.6%) before surgery to -10.2 ± 4.7% (range, -13.8% to 6.1%). The preoperative Rowe and Oxford scores were 56.4 ± 8.5 and 34.7 ± 7.1 respectively, which improved to 94.3 ± 6.7 and 15.3 ± 3.2 at the final follow-up (p < .001). All patients had no limited shoulder joint activity, no re-dislocation or revision surgery, and no neurovascular injury. For recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20%, arthroscopic autologous iliac bone grafting with suture anchor fixation combined with a Bankart repair produced a promising clinical effect. A significant shoulder function score was achieved, as was a 100% bone healing rate and ideal glenoid reconstruction without major complications. Thus, this technique may be considered an alternative to the classic Latarjet approach to treat recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20%. IV.

Direct extrusion of multifascicle prevascularized human skeletal muscle for volumetric muscle loss surgery

Skeletal muscle is composed of multiple fascicles, which are parallel bundles of muscle fibers surrounded by connective tissues that contain blood vessels and nerves. Here, we fabricated multifascicle human skeletal muscle scaffolds that mimic the natural structure of human skeletal muscle bundles using a seven-barrel nozzle. For the core material to form the fascicle structure, human skeletal myoblasts were encapsulated in Matrigel with calcium chloride. Meanwhile, the shell that plays a role as the connective tissue, human fibroblasts and human umbilical vein endothelial cells within a mixture of porcine muscle decellularized extracellular matrix and sodium alginate at a 95:5 ratio was used. We assessed four types of extruded scaffolds monolithic-monoculture (Mo-M), monolithic-coculture (Mo–C), multifascicle-monoculture (Mu-M), and multifascicle-coculture (Mu-C) to determine the structural effect of muscle mimicking scaffold. The Mu-C scaffold outperformed other scaffolds in cell proliferation, differentiation, vascularization, mechanical properties, and functionality. In an in vivo mouse model of volumetric muscle loss, the Mu-C scaffold effectively regenerated the tibialis anterior muscle defect, demonstrating its potential for volumetric muscle transplantation. Our nozzle will be further used to produce other volumetric functional tissues, such as tendons and peripheral nerves.

A Step-by-Step Surgical Technique to the Posterior Auricular "Revolving Door" Flap for Conchal Tumor Excision: A Guide for the Surgical and Dermatological Trainee.

Skin cancer is the most common malignancy worldwide and the auricle is particularly vulnerable to the effects of cumulative sun exposure. Reconstruction of auricular defects after skin cancer excision remains a vexing surgical challenge owing to the complex three-dimensional- anatomy of the external ear, particularly in the conchal bowl. The postauricular island "revolving door" flap is a reliable single-stage method for reconstructing anterior auricular and conchal defects. While the revolving door flap is well known in the literature, a clear description of how to use the flap to reconstruct an anterior auricular conchal bowl defect is lacking. Herein, we present a step-by-step description of the surgical technique, using surgical photos of a patient who presented with basal cell carcinoma on their anterior auricular concha.

Ultrasound biomicroscopy qualitative and quantitative signs of phacoantigenic uveitis.

To describe the ultrasound biomicroscopy (UBM) diagnostic features in patients suspected of experiencing chronic inflammation due to phacoantigenic uveitis SUBJECTS/METHODS: This single-center study enrolled patients referred to the Uveitis Department of Cleveland Clinic Abu Dhabi for chronic anterior uveitis and traumatic cataract. Patients' demographics, causes and dates of the inciting traumatic event, and ophthalmic findings were recorded. 20-MHz UBM assessment of the status of the anterior capsule and the crystalline lens was performed. Then, cataract surgery was performed using a single technique. Comparison of the anterior capsule and lens status by clinical, UBM, and intraoperative evaluation. Forty eyes with phacoantigenic uveitis were considered. The slit-lamp examination could identify interruption of the anterior capsule in 20% of the eyes and liquefied sinking lens material in 10%. An intra-operative defect in the anterior capsule was documented in 87.5% of eyes. UBM imaging showed anterior capsule irregularity in 63.3% of eyes and confirmed the presence of anterior capsule defects in 47.5% and lens matter herniating into the anterior chamber in 15%. Hypoechogenic lacunae within the cataractous lens were detected in 12.5% of eyes. For UBM, sensitivity and specificity values were 82.86% (95% CI: 66.35-93.44) and 100% (95% CI: 47.82-100), respectively. Positive and negative predictive values for UBM were 100% (95% CI: 88.06-100) and 45.45% (95% CI: 28.69-63.32), respectively. The overall diagnostic accuracy of UBM was 85% [95% CI: 70.16-94.29]. Ultrasound Biomicroscopy (UBM) is essential for assessing suspected anterior capsule ruptures in phacoantigenic uveitis cases.

Endoscopic Integrated Multipoint Laser System to Perform Quantitative Measurements for Anterior Skull Base Defects.

Measurements in endoscopic sinus surgery (ESS) are usually obtained with variable accuracy. We aimed to validate endoscopic multipoint integrated laser systems (EIMLS) for use in ESS, which can acquire measurements within one-hundredth of a millimetre. A 4.4 mm flexible endoscopic EIMLS projecting 49 laser points into the view was used to assess simulated anterior skullbase defects. Antero-posterior and lateral measurements were obtained and repeated 20 times by two surgeons. These were compared to measurements with surgical callipers. Intra and inter-observer reliability was assessed. Eighty measurements were obtained of simulated skullbase defects by each otolaryngology surgeon and compared to manual measurements. The mean difference shown was 0.56 cm. Bland-Altman plot shows low bias (0.044) but wide 95% limits of agreement (-1.8-1.9). EIMLS allows reliable and easy to obtain measurements within a simulated ESS environment. Translation of this technology offers promise in a future clinical setting but will require further refinement to improve accuracy.

Effect of Sclerosis Bands in Femoral Head Necrosis on Non-Vascularized Fibular Grafting-A Finite Element Study.

Femoral head necrosis is a challenging condition in orthopaedics, and the occurrence of collapse is an important factor affecting the prognosis of femoral head necrosis. Sclerosis bands are known to influence the collapse of the femoral head, yet there is a lack of research on the biomechanical role of sclerosis bands in non-vascularized fibular grafting surgery. This study aims to evaluate the biomechanical impact of sclerosis bands in femoral head necrosis and their role in non-vascularized fibular grafting surgery (NVFG) using finite element analysis. We constructed 11 finite element models based on CT scan data of a normal hip joint, simulating different sclerosis band thicknesses and defect scenarios. The models were analyzed for changes in femoral head displacement and von Mises stress. We constructed a hip joint model based on CT data from a normal hip joint, and after reconstruction, assembly, and optimization using 3-matic. We created five groups consisting of 11 finite element analysis models of the hip joint. Mesh partitioning and mechanical parameter settings were performed in ANSYS. The changes and differences in femoral head displacement and von Mises stress of these models were analyzed. Increasing sclerosis band thickness led to reduced peak displacement of the femoral head by 28.6%, 42.9%, and 47.6%, and increased surface von Mises stress by 28.3%, 13.8%, and 13.0%, respectively. Post-surgery, peak displacement decreased in all groups compared to pre-surgery levels. Increasing sclerosis band thickness post-surgery resulted in decreased maximum von Mises stress of the femoral head by 13.9%, 3.0%, and 8.1%. Defect volume in the defect groups correlated with increased peak displacement of the femoral head by 10.0%, 30.0%, and 100.0%, and increased surface maximum von Mises stress of the femoral head by 9.3%, 14.0%, and 15.1%. Sclerosis band formation exacerbates von Mises stress concentration on the femoral head surface. However, thicker sclerosis bands improve post-NVFG stability and mechanical performance. Larger anterior lateral sclerosis band defects significantly compromise postoperative stability, increasing the risk of collapse. Protecting the anterior lateral sclerosis band during NVFG surgery is crucial.

Radiologic and Histological Evaluation of Allogenic Bone graft Blocks in Bounded Anterior Maxillary Alveolar Ridge Defects

Radiologic and Histological Evaluation of Allogenic Bone graft Blocks in Bounded Anterior Maxillary Alveolar Ridge Defects

Novel Vaginal Cerclage Assisted Laparoscopic Cervico-Sacropexy Technique for Uterovaginal Prolapse.

Laparoscopic hysteropexy is a complicated procedure that requires specialized surgical skills, including precise dissection and suturing. The aim is to describe the technical considerations for performing a new, feasible, and minimally invasive technique to correct apical and concurrent apical and anterior vaginal wall defects. A retrospective analysis was conducted on 70 consecutive women who underwent surgery for stage ≥3 uterovaginal prolapse. As a part of the technique, an anterior 2-cm long transverse incision was made at the anterior cervicovaginal junction, and the bladder was dissected through blunt and sharp dissection to the level of the isthmus. A posterior colpotomy was performed. A polypropylene tape was inserted into the cervical connective tissue, and the free arms of the tape were inserted into the peritoneum via the posterior colpotomy. Two arms of the tape were passed from the tunnel parallel and medial to a right sacrouterine fold, then fixed to the anterior longitudinal ligament via the laparoscopic route. The tape can be inserted into the cervix in a median of 15min, and the laparoscopy procedure can be completed in 24min. No mesh erosion or long-term complications occurred. At a 1-year control, there were no cases of recurrence. This novel cervico-sacrocolpopexy technique is a feasible and safe, minimally invasive way to correct apical or multicompartment defects, with a short operation time and an anatomical result that mimics the normal sacrouterine ligament.