Early Experience Research Articles

Representations of Chagas disease among Bolivian immigrants in the city of São Paulo

BackgroundTransnational immigrants are particularly impacted by neglected diseases, which take a heavy biological, social, and emotional toll in these marginalized communities. Chagas disease has transformed from an exclusively rural to an increasingly urban phenomenon encompassing non-endemic areas in Latin America.MethodsThrough semi-structured interviews, we investigated representations of Chagas disease in Bolivian immigrants in São Paulo, Brazil. Between August and September 2015, 27 adult migrants were interviewed, 11 of them with Chagas disease. We explored problems of access to health services and essential knowledge about the disease, as well as related conceptions and health practices.ResultsParticipants constructed social representations of Chagas through interactions with family and social networks, drawing on earlier experiences in Bolivia. Diagnosis often provoked fear, and participants faced barriers to care based on language differences and uncertainties about the disease and treatment options. Healthcare personnel played an important role in alleviating concerns and facilitating access to information.DiscussionThe complex intersection of migration and neglected diseases creates challenges for local and national health programs, requiring innovative responses incorporating the perspectives and needs of the often vulnerable affected communities.

The longitudinal impact of pre- and postnatal maternal depression and anxiety on children's cognitive and language development.

We investigated the longitudinal associations among maternal pre- and postnatal depression, maternal anxiety, and children's language and cognitive development followed from 15 to 61 months. Furthermore, we assessed the protective role of children's early print experiences with books against the adverse effect of maternal depression on language development. Data for mothers and children (51.7% boys, 95% White, N = 11,662) were from the Avon Longitudinal Study of Parents and Children. Prenatal maternal depression held an adverse association with child language (β = -.16, p = .002). Moreover, the risk was greater for girls than boys (β = .19, p = .02). In addition, prenatal depression was significantly and negatively associated with child verbal intelligence quotient (β = -.11, p = .02) and performance intelligence quotient (β = -.12, p = .01). In contrast, postnatal depression or anxiety were not unique predictors of child outcomes. Importantly, children's early experiences with books, as measured by the reported frequency of parent-child shared reading, moderated the negative association between maternal depression and child language development (β = .30, p < .001). Although modest in size, these findings inform models of child risk and resilience related to maternal psychopathology. The results also have implications for clinical programs as well as for prevention and intervention studies focusing on at-home early literacy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adverse childhood experiences and insecure attachment: The indirect effects of dissociation and emotion regulation difficulties.

Difficulties with dissociation and emotion regulation are well-documented reactions to early adverse childhood experiences (ACEs). Although findings identify dissociation and emotion dysregulation as explaining the relationship between various forms of ACEs and adult psychopathology, less is known about their combined effect in the relationship between ACEs and insecure attachment in adulthood. This study examined the indirect effects of dissociation and emotion regulation difficulties in the relationship between early adverse experiences and insecure attachment traits. Participants (N = 260) completed an online questionnaire measuring ACEs, dissociation, emotion regulation difficulties, and anxious and avoidant attachment. Results indicated that, after controlling for mental health treatment, dissociation and emotion regulation difficulties explained the relationship between ACEs and insecure (anxious and avoidant) attachment. Emotion regulation difficulties were not a significant predictor of avoidant attachment. Findings provide support for greater research on mediating factors in the maintenance of insecure attachment across development and potential implications of dissociation and emotion regulation in clinical and nonclinical populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Long-term outcomes of chimney endovascular aneurysm repair procedure for complex abdominal aortic pathologies

ObjectivesTo update our earlier experience and to evaluate long-term outcomes of chimney endovascular aortic repair performed for selected cases with complex abdominal aortic aneurysm. MethodsA single-centre retrospective cohort study was conducted on 51 consecutive patients who underwent chimney endovascular aortic repair procedure, deemed unfit for open surgical repair and fenestrated endovascular aneurysm repair, from October 2009 to November 2019. Kaplan-Meier analyses were used to assess the estimated overall survival, freedom from aneurysm related mortality, freedom from reintervention, freedom from target vessel instability and freedom from type Ia endoleaks. ResultsFifty-one patients (mean age, 77.1 ± 7.5 years) with a mean preoperative maximum aneurysm diameter of 74.2 (± 20.1) mm were included. Mean follow-up duration was 48.6 months (range. 0 – 136 months). Estimated overall survival at 5 and 7 years was 36.3% (± 7.1%) and 18.3% (± 6.0%), respectively. Freedom from aneurysm-related mortality was 88.6% (± 4.9%) at 7 years. Estimated freedom from type Ia endoleak at 7 years was 91.9% (± 3.9%). A total of 21 late reinterventions were performed in 17 (33%) patients. Most of them were performed to treat type II endoleaks with sac growth (47.6%, n = 10) and type Ib endoleak (23.8%, n = 5). Estimated freedom from reintervention at 7 years was 56.3% (± 7.9%). Estimated freedom from target vessel instability at 7 years was 91.5% (± 4.1%). ConclusionsThe 7-year results of chimney endovascular aortic repair procedures performed in our centre confirm the long-term safety and effectiveness of this technique in a series of high-risk patients with large aneurysms. The present study has, to the best of our knowledge, the longest follow-up for patients treated with chimney endovascular aortic repair, and it provides data to the scarce literature on the long-term outcomes of this procedure, showing acceptable to good long-term results.

Chinese University Students' Growth in Critical Thinking: Accounting for School Transition and Selection Effects

Evaluating cognitive ability and skills development in higher education presents challenges because the focal outcome often serves as, or at least is reflected in, selection criteria for college admission decisions. Additionally, the baseline abilities and skills gained from earlier educational experiences impact students' further learning outcomes. To address these challenges, we propose an integrated framework for estimating students' growth that accounts for lasting transition effects and varying selection effects. Using a nationally representative longitudinal sample of Chinese university students, we found that students experienced medium-sized growth (0.67) in critical thinking skills, with a large effect size observed for evaluating the reasoning of an argument, a medium effect size for evaluating argument implications, and no significant growth in evaluating argument credibility. Our estimates of transition effects showed that the impact of earlier education experience on students' critical thinking growth diminished in the college years. After controlling students' socioeconomic status and the college entrance examination scores, we found that the within-university advantage in the college entrance examination served as a factor in explaining the university impacts on students’ critical thinking. Our findings provide rich insights into improving the evaluation of critical thinking skills in Chinese universities, and our illustrative framework can also be applied to similar education contexts.

Preservice Teachers’ Assessment Literacy Within Models-Based Practice

Purpose: Using the assessment literacy framework, the purpose of this study was to explore preservice teachers understanding and enactment of the message system during an early field experience. Method: Six PTs employed SE seasons totaling 540 min. Seven qualitative data methods were utilized. Data analysis included deductive and inductive analysis using a thematic approach. Trustworthiness included data triangulation, peer debriefing, negative case analysis, and the maintenance of an audit trail. Results: Three main themes derived from the data included: instructional decisions were driven by the SE model and informal assessment; formal assessment was driven by the structure of SE; and high assessment value but low assessment literacy. Discussion/Conclusion: The SE model drove PTs to use formal assessment, but primarily in an evaluative manner. The PTs lacked assessment literacy, felt pressure to follow the model, did not use assessment to inform teaching, and had concerns for future assessment use.

Strengthening through adversity: The hormesis model in developmental psychopathology.

Employing a developmental psychopathology framework, we tested the utility of the hormesis model in examining the strengthening of children and youth through limited levels of adversity in relation to internalizing and externalizing outcomes within a brain-by-development context. Analyzing data from the Adolescent Brain and Cognitive Development study (N = 11,878), we formed latent factors of threat, deprivation, and unpredictability. We examined linear and nonlinear associations between adversity dimensions and youth psychopathology symptoms and how change of resting-state functional connectivity (rsFC) in the default mode network (DMN) from Time 1 to Time 5 moderates these associations. A cubic association was found between threat and youth internalizing problems; low-to-moderate family conflict levels reduced these problems. Deprivation also displayed a cubic relation with youth externalizing problems, with moderate deprivation levels associated with fewer problems. Unpredictability linearly increased both problem types. Change in DMN rsFC significantly moderated the cubic link between threat levels and internalizing problems, with declining DMN rsFC levels from Time 1 to Time 5 facilitating hormesis. Hormetic effects peaked earlier, emphasizing the importance of sensitive periods and developmental timing of outcomes related to earlier experiences. Strengthening through limited environmental adversity is crucial for developing human resilience. Understanding this process requires considering both linear and nonlinear adversity-psychopathology associations. Testing individual differences by brain and developmental context will inform preventive intervention programming.

"Cold feet": A qualitative study of medical students who seriously considered emergency medicine but chose another specialty.

Emergency medicine (EM) has historically been among the most competitive specialties in the United States. However, in 2022 and 2023, 219 of 2921 and 554 of 3010 respective National Resident Matching Program positions were initially unfilled. Medical students' selection of a medical specialty is a complex process. To better understand recent trends in the EM residency match, this qualitative study explored through one-on-one interviews the rationale of senior medical students who seriously considered EM but ultimately pursued another specialty. A convenience sample of senior medical students from across the United States was recruited via multiple mechanisms after the 2023 match. Participant characteristics were collected via an online survey. Qualitative data were generated through a series of one-on-one semistructured interviews and thematic analysis of the data was performed using a constant comparative approach. Sixteen senior medical students from 12 different institutions participated in the study. Thematic saturation was reached after 12 interviews but data from all 16 interviews were included for qualitative analyses. Five major themes emerged as important in students' consideration but ultimate rejection of EM as a career: (1) innate features of EM attracted or dissuaded students, (2) widespread awareness of a recent workforce report, (3) burnout in EM, (4) their perception of EM's standing in the health care landscape, and (5) early EM experience and exposure. This qualitative study identified five major themes in the career decisions of senior medical students who seriously considered EM but chose another specialty. These findings may help inform the perceptions of students and guide future EM recruitment efforts.

유아의 코딩놀이 경험에 따른 수학적 문제해결력과 스마트폰 중독의 차이 및 관계 분석

Objectives The purpose of this study was to examine the difference between mathematical problem-solving ability and smartphone addiction according to the experience of coding play in 5-year-old children, and the relationship between mathematical problem-solving ability and smartphone addiction.&#x0D; Methods To achieve the objectives of this study, 135 5-year-old children enrolled in early childhood education institution located in Gyeonggi Province were selected as research subjects. Data were collected through interviews with the children and questionnaires administered to their parents. Descriptive statistics, t-tests, and correlation analyses were conducted using the SPSS WIN 24.0 program to analyze the collected data.&#x0D; Results First, it was found that children with coding play experiences demonstrated higher mathematical problem- solving abilities than those without such experiences. Additionally, children with coding play experiences showed higher abilities in number and operation, algebra, and measurement. Smartphone addiction was also higher in children with coding play experiences, and they exhibited higher severity and resistance to smartphone addiction. Second, as the mathematical problem-solving abilities of children with coding play experiences increased, smartphone addiction decreased, and impulsive-compulsive use of smartphones was lower. Moreover, among the subfactors of mathematical problem-solving abilities, higher geometric and statistical abilities were associated with lower severity of smartphone addiction, withdrawal symptoms, daily life issues, and interpersonal conflicts. In contrast, there was no significant correlation between mathematical problem-solving abilities and smartphone addiction in children without coding play experiences.&#x0D; Conclusions The study suggests that early experiences with coding play can contribute to the development of mathematical problem-solving skills in 5-year-old children. However, it also indicates a potential risk of smartphone addiction. Nevertheless, the study demonstrates that higher mathematical problem-solving abilities in children with coding play experiences are associated with a lower risk of smartphone addiction. This highlights the importance of mathematical problem-solving skills, which can reduce the risk of early childhood smartphone addiction while enhancing the educational effects of coding play.&#x0D;

Clinical practicality and patient performance for surface-guided automated VMAT gating for DIBH breast cancer radiotherapy

Background and purposeTo evaluate the performance of automated surface-guided gating for left-sided breast cancer with DIBH and VMAT. Materials and methodsPatients treated in the first year after introduction of DIBH with VMAT were retrospectively considered for analysis. With automated surface-guided gating the beam automatically switches on/off, if the surface region of interest moved in/out the gating tolerance (±3 mm, ±3°). Patients were coached to hold their breath as long as comfortably possible. Depending on the patient’s preference, patients received audio instructions during treatment delivery. Real-time positional variations of the breast/chest wall surface with respect to the reference surface were collected, for all three orthogonal directions. The durations and number of DIBHs needed to complete dose delivery, and DIBH position variations were determined. To evaluate an optimal gating window threshold, smaller tolerances of ±2.5 mm, ±2.0 mm, and ±1.5 mm were simulated. Results525 fractions from 33 patients showed that median DIBH duration was 51 s (range: 30–121 s), and median 4 DIBHs per fraction were needed to complete VMAT dose delivery. Median intra-DIBH stability and intrafractional DIBH reproducibility approximated 1.0 mm in each direction. No large differences were found between patients who preferred to perform the DIBH procedure with (n = 21) and without audio-coaching (n = 12). Simulations demonstrated that gating window tolerances could be reduced from ±3.0 mm to ±2.0 mm, without affecting beam-on status. ConclusionIndependent of the use of audio-coaching, this study demonstrates that automated surface-guided gating with DIBH and VMAT proved highly efficient. Patients’ DIBH performance far exceeded our expectations compared to earlier experiences and literature. Furthermore, gating window tolerances could be reduced.

Early Clinical Outcomes of Thoracoscopic Major Pulmonary Resection and Thymectomy Using Novel Articulating Endoscopic Forceps.

Video-assisted thoracoscopic surgery (VATS) is recognized as a safe and effective treatment modality for early-stage lung cancer and anterior mediastinal masses. Recently, novel articulating instruments have been developed and introduced to endoscopic surgery. Here, we share our early experiences with VATS major pulmonary resection and thymectomy performed using ArtiSential articulating instruments. At the Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 500 patients underwent VATS pulmonary resection between July 2020 and April 2023, while 43 patients underwent VATS thymectomy between January 2020 and April 2023. After exclusion, 224 patients were enrolled for VATS major pulmonary resection, and 38 were enrolled for VATS thymectomy. ArtiSential forceps were utilized in 35 of the 224 patients undergoing pulmonary resection and in 12 of the 38 individuals undergoing thymectomy. Early clinical outcomes were retrospectively analyzed. No significant differences were observed in sex, age, surgical approach, operation time, histological diagnosis, or additional procedures between the patients who underwent surgery using novel articulating instruments and the group treated with conventional endoscopic instruments for both VATS major pulmonary resection and thymectomy. However, the use of the novel articulating endoscopic forceps was associated with a significantly larger number of dissected lymph nodes (p=0.028) and lower estimated blood loss (p=0.009) in VATS major pulmonary resection. Major pulmonary resection and thymectomy via VATS using ArtiSential forceps were found to be safe and effective, with early clinical outcomes comparable to established methods. Further research into long-term clinical outcomes and cost-effectiveness is warranted.

Psychopathology as long-term sequelae of maltreatment and socioeconomic disadvantage: Neurocognitive development perspectives.

Neuroscience research underscores the critical impact of adverse experiences on brain development. Yet, there is limited understanding of the specific pathways linking adverse experiences to accelerated or delayed brain development and their ultimate contributions to psychopathology. Here, we present new longitudinal data demonstrating that neurocognitive functioning during adolescence, as affected by adverse experiences, predicts psychopathology during young adulthood. The sample included 167 participants (52% male) assessed in adolescence and young adulthood. Adverse experiences were measured by early maltreatment experiences and low family socioeconomic status. Cognitive control was assessed by neural activation and behavioral performance during the Multi-Source Interference Task. Psychopathology was measured by self-reported internalizing and externalizing symptomatology. Results indicated that higher maltreatment predicted heightened frontoparietal activation during cognitive control, indicating delayed neurodevelopment, which, in turn predicted higher internalizing and externalizing symptomatology. Furthermore, higher maltreatment predicted a steeper decline in frontoparietal activation across adolescence, indicating neural plasticity in cognitive control-related brain development, which was associated with lower internalizing symptomatology. Our results elucidate the crucial role of neurocognitive development in the processes linking adverse experiences and psychopathology. Implications of the findings and directions for future research on the effects of adverse experiences on brain development are discussed.

Fuzzy logical system for personalized vocal music instruction and psychological awareness in colleges using big data

Traditional psychological awareness relating to vocal musical instruction often disregards the impact of earlier experiences on music learning could result in a gap in meeting the needs of individual students. Conventional learning techniques of music related to psychological awareness for each individual has been focused on and addressed in this research. Technological upgrades in Fuzzy Logic (FL) and Big Data (BD) related to Artificial Intelligence (AI) are provided as a solution for the existing challenges and provide enhancement in personalized music education. The combined approach of BD-assisted Radial Basis Function is added with the Takagi Sugeno (RBF-TS) inference system, able to give personalized vocal music instruction recommendations and indulge psychological awareness among students. Applying Mel-Frequency Cepstral Coefficients (MFCC) is beneficial in capturing variant vocal characteristics as a feature extraction technique. The BD-assisted RBF can identify the accuracy of pitch differences and quality of tone, understand choices from students, and stimulate psychological awareness. The uncertainties are addressed by using the TS fuzzy inference system and delivering personalized vocal training depending on different student preference factors. With the use of multimodal data, the proposed RBF-TS approach can establish a fuzzy rule base in accordance with the personalized emotional elements, enhancing self-awareness and psychological well-being. Validation of the proposed approach using an Instruction Resource Utilization Rate (IRUR) gives significant improvements in engaging students, analyzing the pitching accuracy, frequency distribution of vocal music instruction, and loss function called Mean Square Error(MSE). The proposed research algorithm pioneers a novel solution using advanced AI algorithms addressing the research challenges in existing personalized vocal music education. It promises better student outcomes in the field of music education.

High yield clinical applications for photon counting CT in neurovascular imaging.

Photon-counting CT uses a novel x-ray detection mechanism that confers many advantages over that used in traditional energy integrating CT. As photon-counting CT becomes more available, it is important to thoroughly understand its benefits and highest yield areas for improvements in diagnosis of various diseases. Based on our early experience, we have identified several areas of neurovascular imaging in which photon-counting CT shows promise. Here, we describe the benefits in diagnosing arterial and venous diseases in the head, neck, and spine. Specifically, we focus on applications in head and neck CT angiography, spinal CT angiography, and CT myelography for detection of CSF-venous fistulas. Each of these applications highlights the technological advantages of PCCT in neurovascular imaging. Further understanding of these applications will not only benefit institutions incorporating PCCT into their practices but will also help guide future directions for implementation of PCCT for diagnosing other pathologies in neuroimaging.

A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification.

Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS. A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system. Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU. This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS. III - Retrospective comparative study.

The long and winding road: Pathways from basic research to implementation and evaluation.

In this article, we celebrate Dante Cicchetti's extensive contributions to the discipline of developmental psychopathology. In his seminal article, he articulated why developmental psychopathology was imperative to create research portfolios that could inform the causes, consequences, and trajectories for adults often initiated by early lived experiences (Cicchetti, 1984). In this three-part article, we share our transdisciplinary efforts to use developmental psychopathology as a foundational theory from which to develop, implement, and evaluate interventions for populations who experienced early adversity or who were at risk for child abuse and neglect. After describing interventions conducted at Mt. Hope Family Center that spanned over three decades, we highlight the criticality of disseminating results and address policy implications of this work. We conclude by discussing future directions to facilitate work in developmental psychopathology. Currently, one of three national National Institute of Child Health and Human Development-funded child abuse and neglect centers, we look forward to continuing to build upon Dante's efforts to disseminate this important work to improve society for our children, our nation's often most vulnerable and forgotten citizens.

Developmental plasticity: a worm's eye view.

Numerous examples of different phenotypic outcomes in response to varying environmental conditions have been described across phyla, from plants to mammals. Here, we examine the impact of the environment on different developmental traits, focusing in particular on one key environmental variable, nutrient availability. We present advances in our understanding of developmental plasticity in response to food variation using the nematode Caenorhabditis elegans, which provides a near-isogenic context while permitting lab-controlled environments and analysis of wild isolates. We discuss how this model has allowed investigators not only to describe developmental plasticity events at the organismal level but also to zoom in on the tissues involved in translating changes in the environment into a plastic response, as well as the underlying molecular pathways, and sometimes associated changes in behaviour. Lastly, we also discuss how early life starvation experiences can be logged to later impact adult physiological traits, and how such memory could be wired.

Exploring the Relationship Between Age at Nap Cessation and Social-Emotional Functioning in Children.

The objective of this study was to examine variations in age at nap cessation and identify whether there is an association with social-emotional functioning (SEF) as measured by internalizing/externalizing behavior, child temperament, and social skills in a sample of early childhood education and care-attending children. The sample comprised 1117 children from the Australian Effectiveness Early Educational Experiences for Children longitudinal early childhood study. We used children's age at nap cessation as retrospectively recalled by caregivers in 2011 or 2013 when children were between ages 2 and 7 years. Each child's SEF was reported by a caregiver using the Strengths and Difficulties Questionnaire, the Short Temperament Scale for Children, and the Social Skills Inventory Scale. Associations between children's age of nap cessation and SEF were tested using linear regressions. The children's age at nap cessation ranged from 6 months to 6 years. For each additional year of napping, children's total, conduct, externalizing, and peer behavior problems decreased by 0.39 (95% confidence interval [CI], -0.70 to -0.09), 0.11 (95% CI, -0.21 to -0.01), 0.11 (95% CI, -0.51 to -0.06), and 0.11 (95% CI, -0.20 to -0.02) units on the Strengths and Difficulties Questionnaire scale, respectively. No further significant associations were found. This is the first study reporting the age range of nap cessation and its associations with social-emotional functioning. Our findings demonstrate earlier cessation ages in Australian children attending Early Childhood Education and Care programs than previously reported and a small association with externalizing and peer problems.

Revision Total Ankle Arthroplasty Using the INBONE II System.

The utilization of total ankle arthroplasty (TAA) for managing severe ankle osteoarthritis has become increasingly common, leading to a higher occurrence of revision TAA procedures because of failure of primary TAA. This study aims to examine the clinical results associated with revision TAA using the INBONE II system. Given the growing number of TAA revision procedures and a focus on motion-preserving salvage options, we evaluated our early experience with revision TAA. A retrospective analysis was conducted on a group of 60 presumed noninfected patients who underwent revision TAA with the INBONE II system. Detailed information was collected on patient demographics, implant characteristics, concurrent procedures, and complications. The implant survival was estimated using Kaplan-Meier analysis. The study revealed high complication rates but generally fair clinical outcomes for revision TAA using the INBONE II system. Complications were observed in 22 patients (36.7%), including persistent pain (n = 6), nerve injury/impingement (n = 5), infection (n = 3), fracture (n = 3), implant failure (n = 3), impaired wound healing (n = 2), and osteolysis (n = 3). The 3-year survivorship rate from reoperation was 92.0% (82.7%-100.0%) whereas the 3-year survivorship rate from major complications was 90.4% (80.8%-100.0%). We report high complication rates but generally fair clinical results for revision TAA utilizing the INBONE II system. Level IV, retrospective case series study.

Reconstruction of Composite Mandible Defects Using a Cellular Bone Allograft and Soft Tissue Free Flap Coverage

Study Design Retrospective case series. Objective Cellular bone allografts (CBAs) contain the components of a successful bone graft with no autologous component and have been used extensively outside the head and neck. Descriptions of their utilization for mandible reconstruction are limited. We review our experience utilizing a CBA, with no autologous component, for the reconstruction of mandible defects. Methods Patients undergoing reconstruction of a composite mandible defect with a CBA, no added autologous component, within a patient-specific graft cage and soft tissue free flap coverage were retrospectively identified. Graft survival and defect management are assessed and results of post-operative imaging reported. Results Five subjects, aged 23–56 years, underwent reconstruction of mandible defects with the described technique. Defects resulted from gunshot wounds in 4 patients and the composite resection of a low-grade malignancy in one. The defect was definitively managed in 4 subjects, 3 of which had post-operative imaging demonstrating bone formation. The fifth experienced graft failure after developing an orocutaneous fistula and was successful salvaged with an osteocutaneous fibula free flap. Conclusions Our early experience is promising that a CBA, with no autologous component, and soft tissue free flap coverage can be used for the reconstruction of composite mandible defects in select patients.