External Prosthetics Research Articles

Translational Aspects of 3D and 4D Printing and Bioprinting.

Three-dimensional (3D) printed medical devices include orthopedic and craniofacial implants, surgical tools, and external prosthetics that have been directly used in patients. While the advances of additive manufacturing techniques in the production of medical devices have been on the rise, clinical translation of living cellular constructs face significant limitations in terms of regulatory affairs, process technology, and materials development. In this perspective, the current status-quo of 3D and four-dimensional (4D) (bio)printing is summarized, current advancements are discussed and the challenges that need to be addressed for improved industrial translation and clinical applications of bioprinting are highlighted. It is focused on a multidisciplinary approach in discussing the key translational considerations, from the perspective of industry, regulatory bodies, funding strategies, and future directions.

An outlook on regulatory aspects of 3D printing in pharmaceutical and medical sectors

Since the time of origin, three-dimensional printing has not only mesmerizing the researchers also health professionals too. Even though the process is exciting, it involves fussy coordination and selection process to get a desirable product. Still the manufactures are in confusion state that to follow which regulations and guidelines to gets an approval for their product of 3d printing. The importance of 3D printing has laid to recognize the best suitable product and ways to prevent its misuse. FDA approved more than 100 3D printed medical devices and it includes Orthopedic, Cranial implants, Dental restorations such as crowns and external prosthetics, surgical instruments. It also approved one 3D printed drug product using Zip Dose technique for the treatment of Epilepsy called SPRITAM (levetiracetam). The objective of this review article is to give a brief introduction, history, evolution of 3D printers, their development process, FDA role and guidelines.

Organ Printing

Organ Printing is a branch of regenerative medicine. We aimed to demonstrate this presentation to minimize the death rate of patients who dies only due to the inefficient human organs at the right time. This topic revolves around "The Branch of regenerative Medicine. The contents of the research work are all about the definition of organ printing or bioprinting, its technical types, its process, its benefits and challenges, its estimated marketing rate, and how it can be implemented successfully. The most significant developments in 3Dprinting have come in external prosthetics, cranial or orthopedic implants, and custom airway stents. But it has also proven helpful in surgical planning and has been used in complex open planning and has been used in complex open-heart surgeries, and even Cleveland clinic's total face transplant. Talks of printing human tissues have suggested than organ transplants may one day be obsolete. Mind-blowing innovations are coming to medicine and healthcare almost every single day; hope the research paper is one among them with its own unique characteristics.

Limb amputations and prosthetics

Currently, the number of patients with high-energy injuries of large segments of the skeleton due to road traffic and catotrauma is increasing. The number of patients with vascular pathology and disorders of the endocrine system is also increasing, which leads to a sharp increase in the population of patients who underwent limb amputation. Patients who underwent limb amputations present a significant medical and social problem. Stump malformations formed due to violations of surgical technique during reconstructive operations often complicate prosthetic fitting and the social adaptation of patients in this group. The possibilities of external prosthetics manufacturing are currently booming. Limb prosthetics manufacturing is a complex orthopedic, technical, biomechanical and general medical process, which results in medical and social rehabilitation. Functional results depend on the timing of prosthetics manufacturing. An important condition for safe walking is the preparation of a disabled person from the first days after amputation. An important role in the patient's rehabilitation is played by the school of walking, the purpose of which is to form the correct stereotype of walking, to learn how to walk on the prosthesis on various surfaces and to master actions in emergency situations.

Peculiarities of ocular prosthetics in congenital anophthalmia and microphthalmia

Aim to determine optimal terms of the primary ocular prosthetics, to develop the most auspicious regimen of adaptation to the ocular prosthesis in children with congenital anophthalmia and microphthalmia.
 Material and methods. A total of 46 children aged from 1 month to 16 years with congenital defect were under observation. Among patients with congenital microphthalmia, only unpromising eyes were subject to ocular prosthetics. Examination methods in the laboratory included external examination of the orbit, palpebral fissure, and eyelids. The state of the cul-de-sac of eyelids, the configuration of the conjunctival cavity, the anterior segment of the abnormally small eyeball were assessed. Photography was performed to achieve a dynamic control of external prosthetics signs of, and to evaluate the face symmetry.
 Results. Best results were observed at early stepwise ocular prosthetics with consideration of features of the ocular prosthesis material, without prior surgery. Long-term cosmetic performance of children with congenital anophthalmia and microphthalmia directly depended on age at which the non-surgical treatment began, on the timely replacement of the ocular prosthesis, compliance to the regimen developed for the adaptation to the prosthesis.
 Conclusion. This study showed that the terms of primary ocular prosthetics are of crucial importance for the symmetrical development of soft tissues and facial skeleton. Prosthetics for patients with congenital anophthalmia should be started at the first month of life. The optimal term for primary prosthetics in congenital microphthalmia depends on the length of the antero-posterior axis at birth. If the axial length is less than 7.5 mm, prosthetics should be started at the first month of life, if the axis is longer than 10 mm no later than from the fourth month of life.

The current pattern of reconstructive surgery for breast cancer

In Russia, breast cancer (BC) occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %). While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in reference to the lower rate of the manifestation of lymphedemas. However, patients who have undergone this or that mastectomy are observed to have lower self-appraisal scores, a change in their professional sphere, irritability and apprehensiveness Thus, the decreased rate of the manifestation of lymphedema and obvious postoperative traumatization are not the only components of quality of life in patients with BC. According to the data obtained by E. Frank et al. (1978), G.P. Maguire et al. (1978), and F. Meerwein (1981), removal of the breast itself leads to a woman’s loss of femininity, attractiveness, and sexiness, which was also confirmed and reported by L. Aerts et al. (2014). In this connection, classical radical mastectomy begins to give way to organ-sparing treatment. Taking into account that psychotherapy and external prosthetics do not alleviate the above problems and that there are always women with established BC who have contraindications to organ-sparing treatment, breast reconstructive plastic operations arouse more and more interest. Reconstruction of the breast implies restoration of both its shape and contours to be maximally brought closer to its preoperative level. However, with regard to cancer alertness to breast reconstructive surgery, not only aesthetic requirements are imposed. The next step in improving quality of life in patients with BC was the emergence and development of breast-sparing mastectomies, the first point of these operations were skin-sparing radical mastectomies that were first described and performed by B. A. Tothu P. Lappert in 1991. In 1997 G. W. Carlson proposed to classify incisions for skin-sparing mastectomy successfully used to the present day. The investigation conducted by R. M. Simmons et al. (1999) indicated that skin-sparing mastectomy did not result in an increase in the incidence of local recurrences. The types of skin incisions, which were offered by G. W. Carlson in 1997 and used by R. M. Simmons in 1999, imply the preservation of the inframammary crease and a major portion of a skin graft, on the one hand, and the removal of the nipple-areolar complex (NAC), on the other hand, which in turn diminishes the final aesthetic result. B. Gerber et al. were the first to describe NAC preservation for BC. As regards the rate of local recurrences after NAC-sparing mastectomies, the vast majority of investigations performed in the past 10–15 years allude to the fact that NAC involvement is not more than 25 %. A. M. Munhoz in turn proposed a classification of incisions during NAC-saving mastectomies. In spite of all advantages of NAC-sparing mastectomies, their results are not always predictable. Main problems, such as wound healing difficulties or ischemic necrosis, are associated with the larger number of postoperative complications. Transfer of the patient’s own flaps does not always presume skin- or NAC-sparing mastectomy, as the possibility exists of preserving the skin on the most transferable flap. However, ruling out a patch symptom during subcutaneous or skin-sparing radical mastectomy considerably improves the aesthetic result of a performed operation. Taking into consideration that the incision types offered by G. W. Carlson and A. M. Munhoz depend on the site of a tumor, the surgical visibility problem is of relevance: visible postoperative scars, a difference in the skin texture, or restored NAC, all cause the women less satisfied. Thus, by achieving good results in restoring the contours, shape, volume, and symmetry of the breast, a visible postoperative scar is the only element that reveals a performed operation for BC.

Endotracheal Stent Granulation Stenosis Resolution after Colchicine Therapy in a Dog

Endotracheal Stent Granulation Stenosis Resolution after Colchicine Therapy in a Dog

Advances in external prosthetics

Advances in external prosthetics

Interface mechanics in lower-limb external prosthetics: a review of finite element models.

The distribution of mechanical stress at the interface between a residual limb and prosthetic socket is an important design consideration in lower-limb prosthetics. Stresses must be distributed so that the amputee is stable and comfortable, while avoiding trauma to the tissues of the residual limb. Numerical estimation of the stresses at the interface through finite element (FE) modeling can potentially provide researchers and prosthetists with a tool to aid in the design of the prosthetic socket. This review addresses FE modeling of interface stresses in lower-limb external prosthetics. The modeling methodologies adopted by analysts are described. Verification of FE estimates of interface stress against experimental data by different analysts is presented and the likely sources of error discussed. While the performance of the models is encouraging, there are definite limitations to all of them, necessitating further improvements. Parametric analysis of the sensitivity of interface stress to model parameters provides a tool to identify model weaknesses and to suggest possible refinements. Parametric analyses by different analysts are also presented and potential refinements discussed. Finally, directions for future work in prosthetic FE modeling are suggested.

Interface mechanics in external prosthetics: review of interface stress measurement techniques.

Instrumentation to measure accurately the stresses at the interface of a residual limb and prosthetic socket has a strong potential for use in prosthetic treatment. As a tool in the clinical setting, the device would allow a clinician to identify sites of excessive loading, information which could then be combined with clinical assessment of skin quality to determine regions of potential skin breakdown. Stress distributions for different prosthetic designs could be compared, facilitating a clinician's judgement to determine the optimal design for a patient. The instrumentation would have additional use in research as an evaluation tool for computer-based finite-element (FE) models. Stump-socket FE models predict stress distributions for proposed socket designs, thus offering advantages over interface stress measurement because evaluation can be conducted before a prosthesis is fabricated or put on an amputee patient. However, FE models must first be proven valid against experimental measurements before they can be considered accurate predictors of interface stresses. Current interface stress measurement techniques are described, with a concentration on a physical explanation of the advantages and limitations with each technique. New emerging technologies are discussed which are instruments that have been described but for which no data collected on amputees have been reported in the literature. The important new features of those technologies are also discussed.

Issues and themes in computer aided design for external prosthetics and orthotics

Computer aided design systems are finding use in prosthetics and orthotics in the production of customized components to match to and support body segments. Such systems consist essentially at present of shape measurement, computer manipulation of shape, and manufacture of the support surface or its mould. General themes of design philosopy, relationship of shape and pressure for body segments, representation and presentation of shape information by computer, surface adjustments, measurements and manufacturing geometry are considered. Aspects of existing systems are presented to highlight issues which may be the subject of future developments.