Double Barrel Research Articles

Versatility of Vascularized Fibular Graft in Forearm Bone Loss: From Initial Treatment to Secondary Nonunion Treatment

PurposeManaging mangled forearms poses a significant challenge for orthopedic and plastic surgeons. The vascularized fibular graft (FVFG) is a commonly used technique for addressing this complex issue. This retrospective study aims to assess the outcomes of advanced treatment for complex forearm bone loss necessitating microsurgical treatment with a vascularized fibula flap. MethodsPatients treated with vascularized fibula graft (VFG) between January 2010 and December 2022 were included in this analysis. Physical and radiographic evaluations were performed for all patients, and they completed patient-reported outcome measures (PROMs) such as the DASH, Mayo Wrist score, and VAS-Pain scores for both the recipient and donor sites. Patients treated with one-bone forearm reconstruction were also assessed using the Outcome Score of the one-bone forearm according to Peterson (OBF). ResultsA total of 26 cases were treated with VFG for forearm bone defect reconstruction (13 for primary treatment and 13 for secondary treatment of non union). VFG was employed to create a one-bone forearm in 4 cases, a double barrel in 3 cases, and an osteocutaneous composite flap in 9 cases. The average bone defect measured 81 ± 3.4 mm (range 50-150 mm). Bone healing was achieved at an average of 8.3 months ± 5.5 months (4-15 months)., with nonunion at one docking point observed in 8 cases necessitating revision. At the follow-up endpoint, patients reported an average DASH score of 13.5%, a Mayo Wrist score of 80%, and VAS-Pain's score was 3/10. The VAS-Pain outcome at the donor site was rated at 4/10. OBI's mean was 7/10. ConclusionsFVFG stands as a viable option for mangled forearm reconstruction. Whether through the double barrel technique or as an osteocutaneous composite graft, FVFG allows for the simultaneous reconstruction of both forearm bones and associated soft tissue injuries.

Endovascular Reconstruction of Type 3 Central Venous Obstruction: A Case Report

Highlights Abstract Superior vena cava (SVC) syndrome with central thoracic vein occlusion associated with the use of intravascular devices is increasing and involves younger patients. Hemodialysis patients are at higher risk for central vein occlusion and symptomatic SVC syndrome. It is imperative to preserve venous access, particularly for younger patients who will rely on dialysis for an extended duration. Endovascular venous reconstruction is the recommended treatment but there are not standardized guidelines about the type of stent and technique. In the present case report the primary objective was to resolve the central vein occlusion and maintain vein patency through double barrel and Y technique together, employing bare metal and covered stents.

Volumetric Bone Changes in Double Barrel Vascularized Fibula Flap Used for Mandibular Reconstruction: A Randomized Clinical Trial.

To assess the volumetric bone changes in double barrel vascularized fibular flap used for mandibular reconstruction using 3D miniplate versus 3D titanium mesh tray. Twenty patients seeking mandibular reconstruction were selected for this 2-arm parallel randomized clinical trial with a 1:1 allocation ratio. Both groups underwent double-barrel fibula free flap for mandibular reconstruction with fixation of the superior barrel to the inferior barrel using a Titanium mesh (Group A) or a 3D plate (Group B). The primary outcome was volumetric bone changes (immediate to 6 months postoperatively). Eleven participants (55%) were females, and 9 participants (45%) were males. The mean age of patients in group A was (28.8±8.9) years, while group B was (30.7±11.4) years. There was a statistically significant difference within each group in the volumetric bone changes with means of -7942.1±1804.8mm3 and -6288.8±2607.3 for groups A and B, respectively. The difference between both groups was statistically insignificant with the mean of -1653.3±1002.8mm3. The percentage of mean volumetric change relative to immediate postoperatively for group A was -14.15%, while in group B was -11.01%. Both the titanium mesh tray and the 3D plate were effective in the fixation of the superior barrel of the vascularized fibular flap for mandibular reconstruction. There was no difference between both modalities regarding volumetric bone changes.

Anodische H2O2‐Erzeugung in Elektrolyten auf Karbonatbasis – Mechanistische Erkenntnisse Mittels Elektrochemischer Rastermikroskopie

AbstractFür die anodische H2O2‐Bildung kann die Elektrolytzusammensetzung den Reaktionsweg in Richtung einer erhöhten Produktbildung lenken. Frühere Untersuchungen zur Optimierung der Elektrolytzusammensetzung haben gezeigt, dass die Auswirkungen des molaren Anteils der Karbonatspezies für verschiedene Anodenmaterialien unterschiedlich sind, und daher gibt es weiterhin Kontroversen über die Reaktionswege und die an der H2O2‐Bildung beteiligten Spezies. In Anbetracht der Tatsache, dass die Wasseroxidation zur Freisetzung von Protonen in der Anodenmikroumgebung führt, würde die entsprechende Ansäuerung eine Gleichgewichtsverschiebung zwischen den Karbonatspezies bewirken, was wiederum den Reaktionsweg modulieren könnte. Wir haben die Veränderungen im Anteil der Karbonatspezies in der Nähe einer arbeitenden Anode bestimmt, indem wir lokale pH‐Messungen mit einer Au‐Nanoelektrode, die mittels elektrochemischer Scherkraft‐Rastermikroskopie (SECM) in unmittelbarer Nähe einer sich in Betrieb befindlichen Anode positioniert war, durchgeführt haben. Es konnte bestätigt werden, dass die wichtigste anionische Spezies an der Grenzfläche HCO3− ist, und zwar bei Potentialen, bei denen H2O2 bevorzugt gebildet wird, unabhängig vom pH‐Wert im Volumen der Lösung. Die gleichzeitige Verwendung einer Au−Pt‐Doppelmikroelektrode in Generator‐Kollektor‐SECM‐Messungen zeigt, dass die lokale HCO3−Konzentration insgesamt durch den Oxidationsstrom, die Pufferkapazität und den pH‐Wert des Elektrolyten bestimmt wird.

Anodic H2O2 Generation in Carbonate-Based Electrolytes-Mechanistic Insight from Scanning Electrochemical Microscopy.

For the anodic H2O2 generation, it has been shown that the electrolyte composition can steer the reaction pathway toward increased H2O2 generation. Previous efforts made on composition optimization found that the impact of the molar fraction of carbonate species varies for different anodes, and therefore, controversies remain concerning the reaction pathways as well as the species involved in H2O2 formation. Considering that water oxidation results in the liberation of protons within the anode microenvironment, the corresponding acidification would cause an equilibrium shift between carbonate species, which in turn may modulate the reaction pathway. We determined the changes in the fraction of carbonate species in the vicinity of an anode by performing local pH measurements using a Au nanoelectrode positioned in close proximity to an operating anode by shear-force scanning electrochemical microscopy (SECM). It could be confirmed that the main anionic species at the interface is HCO3 -, at potentials where H2O2 is preferentially formed, regardless of the pH value in the bulk. The simultaneous use of a Au-Pt double barrel microelectrode in generator-collector SECM measurements demonstrates that the local HCO3 - concentration is collectively determined by the oxidation current, buffer capacity, and bulk pH of the electrolyte.

Segmental mandibulectomy and microvascular reconstruction with fibula free flap: Comparison between intraoral and extraoral approaches

BackgroundSegmental mandibulectomy and reconstruction of resulting defect can be performed via intraoral approach (IOA) or extraoral approach (EOA). Both approaches have advantages, disadvantages, indications, contra-indications to consider during their selection. ObjectiveTo compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF). MethodsWe conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients’ prognosis were evaluated. Patients’ satisfaction and DAS59 were assessed during follow-up. ResultsAmeloblastoma was the most frequent diagnosis (52.9% by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% by IOA vs 88.2% by EOA). Compared to EOA group, IOA group had fewer intraoperative blood loss (MD = -112.2, 95% CI (-178.9 to -45.5), p = 0.001), higher satisfaction score (MD =1.3, 95% CI (0.9 to 1.7), p ˂ 0.001), and lower DAS59 score (MD = -0.5, 95% CI (-0.7 to -0.2), p ˂ 0.001). ConclusionBoth IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. IOA patients were very satisfied with esthetic outcome than EOA patients. In absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site patients should always be referred to implantologist and/or prosthodontist for teeth restoration to improve functional and esthetic outcomes.

The double barrel Impella exchange: A reliable method for uninterrupted mechanical circulatory support

Classic Impella exchange interrupts flow when the old device is pulled into the aorta before advancing the new device across the aortic valve, threatening circulatory collapse and loss of left ventricular access. In “double barrel,” uninterrupted Impella exchange, the new device is placed into the ventricle alongside the old, where flow is first transitioned completely. Of thirty-one consecutive patients undergoing this procedure, none experienced intraoperative cardiac arrest and 96.8% (30/31) had no new aortic insufficiency. One vascular complication ensued following known preoperative iliac injury. One patient suffered nonembolic stroke; another had subarachnoid hemorrhage. Fifty-five percent (17/31) of patients survived, with 22.6% (7/31) recovering, 25.8% (8/31) undergoing transplant, and 6.5% (2/31) transitioning to durable LVAD. Impella-only survival (83.3%, 10/12) was significantly higher than Impella-ECMO survival (36.8%, 7/19) (OR 14.46, 95% CI 1.74-119.93, p=0.01). We conclude “double barrel” technique is reliable in device-dependent cardiogenic shock patients, offering significant advantage and minimal risk.

Experiences of Drug Surrenderees in Highly Urbanized Cities in Cebu: A Phenomenological Study

This study delves into the experiences of drug surrenderees in highly urbanized cities in Cebu. It further described the experiences of the informants during their engagement with drugs and after their surrender and the impact of the PNP double barrel program on the lives of the informants. It utilized the qualitative research method employing the phenomenological approach. There were 12 informants who were drug surrenderees from Cebu, Cebu City, 4 drug surrenderees from Mandaue City, and 4 drug surrenderees from Lapu-lapu City. The selection of informants was through purposive convenient sampling based on the list of the drug surrenderees of the office of the Barangay Captain and Police Sub-stations of the three 3 highly urbanized cities in Cebu. Seven themes were generated to answer the sub problems of this study. These were Amidst Life Adversities and Predicament; Dangerous Drugs Carry us to Seventh Heaven, Illicit Drugs Energize My Work, The Ill Effects of Drugs Deaden My Neurons, PNP Double Barrel Program Teach Us into A Law Abiding Person, PNP Oplan Tokhang Improve Our Lives, Open New Doors of Life’s Beauty, and Community-Based Programs Lead into a Fruitful Life.

Mandibular Reconsctruction using Double Barrel Costal Non Vascularized Bone Graft with Stereolitographic Three Dimensional Printed Models

Surgeons face problems in reconstructing the facial profile after mandibular resection aesthetically and practically. The stereolithographic method was used in the 3D virtual reconstruction program for preoperative planning. This study aims to document the use of 3D printed models in the reconstruction of mandibular ameloblastoma patients under general anesthesia after segmental resection with non-vascularized autogenous costal bone grafts arranged in double-barrel sequence at Airlangga University Hospital, Surabaya, Indonesia. A single ameloblastoma from an anterior mandibular patient undergoing segmental mandibular resection is reported here. Autodesk Fusion 360 was used preoperatively to simulate anatomical markers, surgical margins, and plate morphology to create 3D models used for plate pre-bending. The graft used for reconstruction is a non-vascularized autogenous costal bone graft which is then stacked with an anteroposterior double-barrel. The patient did not show any severe complications associated with the surgery. Stereolithographic helps determine the extent of the lesion in the mandible. 3D printing improves graft viability by enabling optimal planning of the template, reduces operating room time by pre-bent screw plates, and increases procedural precision. The photo was taken a long time to process using virtual reconstruction software, but it put the surgeon at ease.

Mixing performance of cohesive particles in a double barrel with differential velocity based on DEM

The double barrel with differential velocity (DBDV) was proposed to improve the mixture quality. However, the mixing mechanism of cohesive particles in the DBDV is unclear. So, the mixing performance of cohesive particles in the DBDV was studied. The cohesive force between particles was simulated using a viscous contact model. The effects of linear velocity, inclination and cohesive force on the mixing performance were studied. The mixing process of particles was analyzed through mixing uniformity, mixing time, velocity, and contact forces. The results show that excessive cohesion cannot promote the dispersion of particles in the mixture, affecting production efficiency. The motion intensity of particles in the differential region is stronger than that in the non-differential region. The differential zone is suitable for particle motion with high cohesion. This study reveals the detailed mixing behavior of cohesive particles in DBDV, which provides operational guidance for the actual road material mixing process.

Efficacy of personalized 3D-printed osteotomy guide in maximizing fibular utilization and minimizing graft length for reconstruction of large mandibular defect.

The study addresses the long-standing challenge of insufficient length in vascularized fibular flaps when reconstructing large mandibular defects that require dual-barrel grafts. Employing personalized 3D-printed osteotomy guides, the study aims to optimize fibular utilization and minimize the required graft length. Two reconstruction methods for distal bone defects were compared: a fold-down (FD) group that employed a specialized osteotomy guide for folding down a triangular bone segment, and a traditional double-barrel (DB) group. Metrics for comparison included defect and graft lengths, as well as the graft-to-defect length ratio. Postoperative quality of life was assessed using the University of Washington Quality of Life questionnaire (UW-QoL). Both FD and DB groups achieved successful mandibular reconstruction. Despite larger defects in the FD group (117 ± 31.35mm vs 84 ± 35.34mm, p = 0.028), the used fibula length was not statistically longer in the FD group. The median ratio of graft-to-defect length was also lower in the FD group (1.327 vs 1.629, p = 0.024), suggesting that FD required only 82.47% of the graft length needed in the DB approach. Quality of life scores post-surgery were comparable between the groups. Personalized 3D-printed osteotomy guides enhance fibula graft efficacy for reconstructing larger mandibular defects, necessitating shorter graft lengths while preserving postoperative quality of life. This study confirms the utility of 3D printing technology as an effective and precise tool in orthopedic surgery, particularly for complex reconstructions like large mandibular defects. It suggests a viable alternative that could potentially revolutionize current practices in bone grafting.

Spontaneous Closure of Double Barrel Ileostomy in a Boy following Laparotomy.

Spontaneous Closure of Double Barrel Ileostomy in a Boy following Laparotomy.

An Emergency and Challenging Life-Saving Surgery in a Newborn with Imperforate Anus in a Remote Village in South Sudan – A Case Report

Anorectal malformation, a congenital defect is usually detected at birth and managed by a multispeciality team in a tertiary care hospital. We present a case of a five day old neonate, born in a remote village in South Sudan, who presented in a critical condition to our field hospital and was managed with basic resources. A 5 day old neonate was detected with imperforate anus and presented to our hospital on day 5 with abdominal distension, severe dehydration, tachycardia and tachypnoea. Radiographic investigations revealed findings suggestive of a high ano-rectal malformation. The neonate underwent an emergency exploratory Laparotomy with diversion double barrel Colostomy in a set up catering for adult combatants. The neonate gradually improved before developing burst abdomen managed with emergency wound closure. The neonate gradually accepted breast feeds and was discharged for subsequent need for definitive surgery. This was a challenging surgery with respect to the resources available at a field hospital catering to adult combatants.

Physico-chemical Characterization of Biochar from Different Biomass Materials

Aim: To conduct the physico-chemical analysis of biochar derived from various organic residues, an examination of the physical characteristics including bulk density, water retention capacity, and the chemical properties such as pH, electrical conductivity, cation exchange capacity, total organic carbon, as well as the concentration of macro and micro nutrients were evaluated.
 Study Design: Experiment was conducted in completely randomized design with 7 treatments and 3 replications.
 Place and Duration of Study: The investigation was conducted at Integrated Farming System Research, Karamana, Kerala Agricultural University during 2021-2023.
 Methods: Organic residues from different sources were converted into biochar utilizing a double barrel Biochar Kiln, and subsequently, the biochars were analyzed in a Soil and Plant Analysis laboratory to determine their physical and chemical properties.
 Result: Physio-chemical properties of biochar vary significantly with the choice of feedstock material. Banana pseudostem biochar reported the lowest bulk density (0.21 Mg m-3) and highest water holding capacity (327.74%). All the biochar produced were alkaline in nature, and they contained high cation exchange capacity ranging between 9.34 to 14.10cmol (+) kg-1. Macro and micro nutrient contents were comparatively higher in Limnocharis flava biochar and Banana pseudostem biochar.
 Conclusion: Organic residues can be successfully converted to biochar and results obtained show the suitability of application of produced biochar as a soil amendment.

Novel Method of Calculation of Magnetic Resonance Imaging Perfusion and Comparison of Single versus Double Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass for Revascularisation in Moya Moya Disease

IntroductionMoyamoya disease (MMD) is characterised by supraclinoid internal carotid artery (ICA) narrowing causing cerebral parenchyma to starve. Direct and indirect revascularisation techniques are the treatment norm. We provide a clinicoradiological comparison of single and double barrel superficial temporal artery to middle cerebral artery (STA-MCA) bypass for MMD. The perfusion in cerebral hemispheres and vessel density in DSA have been evaluated using novel algorithms. MethodsDSA, ASL MR imaging methods and Suzuki, Matsushima, Angiographic Outcome Score (AOS) scales were used to quantify perfusion parameters; modified Rankin score (mRS) was used for clinical evaluation. A novel image processing algorithm was designed to perform analysis of ASL sequences and compare perfusion. Vessel density was calculated using connected component analysis on thresholded DSA images. Results54 hemispheres with MMD underwent STA-MCA bypass 42(77.8%) single barrel and 12 (22.2%) double barrel. Clinical outcome - mRS was significant with p<0.001 in single barrel and p=0.001 in double barrel groups. The overall AOS showed improvement post-operatively (p=0.032).Perfusion analysis was performed in 20 hemispheres (13 single barrel; 7 double barrel). MCA territories showed significant improvement in single barrel (2.72%, p=0.0294) and double barrel groups (12.89%, p=0.025). Vessel density calculated in MCA territory, showed an overall post-op improvement (p=1.75 x 10-8). ConclusionDouble barrel STA-MCA bypass clinically as well as radiologically improves perfusion in the ACA as well as MCA territories in MMD. The novel image processing algorithm is an accurate, objective tool to evaluate perfusion in MR images and vessel density in DSA images of MMD.

Distribution and Characteristics of Single and Double Barrel House Type in the Mountainous Areas of South Gangwon Province and North Gyeongsang Province

Distribution and Characteristics of Single and Double Barrel House Type in the Mountainous Areas of South Gangwon Province and North Gyeongsang Province

Double-barrel STA-MCA bypass for a giant thrombosed supraclinoid ICA aneurysm with gangliocapsular infarct – A case report

Extracranial-intracranial (EC-IC) bypass is an essential tool for cerebral revascularization procedure. Superficial temporal artery–middle cerebral artery (STA-MCA) bypass was usually performed using one stem of the STA only. In an attempt to augment the flow and to direct the flow to different ischemic areas of the brain, a “double-barrel” technique is used, in which both branches of the STA are used to revascularize distinct MCA territories. Though there are many advancements in endovascular procedures, still STA MCA bypass plays a role in selected cases. We report a 50 years old female with giant thrombosed supraclinoid segment internal carotid artery (ICA) aneurysm with gangliocapsular infarct presented with vision loss, and limb weakness. Patient underwent double barrel STA-MCA bypass, post operatively patient improved of symptoms and patient was discharged in a stable condition. Though endovascular techniques have evolved exponentially over the last few years, and most of these complex aneurysms can be treated using flow-diverting techniques.Though the need for microsurgical intervention is diminished iin this endovascular era, still the surgeons should think about these revascularization procedures as it gives life-long durable solution.

Nutritional Approach of Neonatal with High Output Stoma Due to Long Segment Hirschsprung Disease: A Case Report

Background: High Output Stoma (HOS) continues to be one of the most challenging problems for pediatrician especially in neonates. One of the most common causes in neonatal HOS is post resection long segment Hirschsprung disease.&#x0D; Case: We reported a case of three-day-old baby boy diagnosed as Hirschsprung diseases with peritonitis possibility and did laparotomy with ileal resection, double barrel ileostomy and biopsy. Nutritional management is a major subject on taking care of this type of neonatal patient. We share our experience in limited facilities with all the patient uniqueness&#x0D; Discussion: Loss of a significant length of the small bowel results in interrelated physiologic events as a result of decreased small intestinal mucosal absorptive cell. This leads to a lesser fraction of ingested food and intestinal secretion thus causing an excessive volume loss. The introduction of early enteral feeds promotes intestinal adaptation, with subsequent weaning off parenteral nutrition. Most off patient with high output stoma will require parenteral nutrition which is associated with acute and long-term complications. In our case, we did early nutritional intervention using parenteral and enteral nutrition, counting ongoing fluid loss trough stoma and adjust it to total daily fluid requirement. We found weight loss during hospitalized due to HOS, and we do catch up at the end. We found difficulties to adjust comparation between enteral and parenteral intake to maintain the weight gain.&#x0D; Conclusion: Although parenteral nutrition is often necessary, at least initially, the therapeutic goal should be to enhance intestinal adaptation and enteral nutrient assimilation, and thereby reduce parenteral nutrition requirements. Daily monitoring for ongoing fluid loss very crucial for adjusting nutrition.

Mixed Heat Transfer in a Double Barrel with Differential Velocity based on CFD-DEM and Experiment

Abstract A double barrel with differential velocity (DBDV) was proposed to improve the mixture quality. Temperature is one of the indexes to evaluate the mixture quality. At present, there are few studies on the heat transfer of DBDV. The heat transfer of particles in DBDV was studied by CFD-DEM to deeply understand the proposed DBDV. The heat transfer process in DBDV was analyzed. The distribution law of temperature field under the coupling effect of particles and fluid was obtained. The influence of fluid speed on particle temperature and the regeneration proportion in DBDV were analyzed and compared with the existing double barrel. And the main heat transfer mode of particles in DBDV was to be obtained. The results show that the mixture temperature in the proposed DBDV is generally higher than that in the existing DB. And the mixture produced by DBDV is not only friendly to the environment, but also the mixture temperature can meet the construction requirements even if more than half of the RAP materials are added to the mixture. Compared with DB, the addition proportion of DBDV is increased by 9.38% - 20.70%. And the reliability of the simulation work was verified by the indoor experiment platform, which lays a foundation for the application of DBDV.

DOUBLE-BARREL DRILL SLEEVE: A SURGICAL INNOVATION FOR PERCUTANEOUS OSTEOTOMY

IntroductionOsteotomy is a key step in distraction osteogenesis. Various techniques of osteotomy have been described with its own benefits and pitfalls. Percutaneous osteotomy using multiple drill holes is one of the most widely used osteotomy techniques. It still remains a challenge however to keep the drill holes aligned prior to the osteotomy. Moreover, the efficacy of percutaneous irrigation practice to keep the temperature low during drilling with this technique is also debatable. With an aim to overcome these challenges, we are introducing a device called the Double Barrel Drill Sleeve (DBDS) to perform percutaneous osteotomies. We attempted to compare this method to the conventional multiple drill holes technique using laboratory experiments and clinical data.Materials &amp; MethodsDBDS has two adjacent parallel barrels that can fit 3.2 to 3.5 mm diameter drill bits. It has a guide member at the drilling end that can be inserted through a pre drilled hole at the near and far cortices of a bone. This provides a constant rotating point for drilling of holes through the barrels. An osteotomy simulation was performed to compare percutaneous drilling with DBDS vis-a-vis a conventional single drill sleeve (SDS) by qualified orthopaedic surgeons, mainly to assess the drilling patterns of both techniques. Percutaneous drilling was done on PVC pipes wrapped in thick sponge to simulate tubular bone with surrounding soft tissue. We also assessed the effect of indirect irrigation on temperature during drilling using the DBDS against a control group on a cadaveric bone model. Ultimately we reviewed our patients who had undergone osteotomy for distraction osteogenesis with DBDS and the conventional technique, and compared their outcomes.ResultsCompletion time for the osteotomy simulation in the DBDS group was significantly faster than the conventional drilling group; 74 seconds to 179 seconds. There was significantly less drilling deviation from the midpoint in the DBDS group as compared to the SDS group. Mean bone temperature during drilling with indirect irrigation using DBDS was significantly lower (32.6'C) compared to the control group (48.4'C). There was no significant difference in healing index between patients treated with DBDS and the conventional method. None of these patients developed non union.ConclusionsPercutaneous drilling with DBDS was quicker and more linear compared to the conventional method. Its double-barreled feature allows effective indirect irrigation during drilling. A comparable healing index in both of the techniques shows its clinical efficacy. These attributes make DBDS a usefull tool to overcome some of the pitfalls associated with the conventional multiple drill holes technique.