Deformity Research Articles

An Update on the Etiopathogenesis and Management of Morbihan Disease: A Narrative Review

: Morbihan disease (MD) is a rare and infrequent condition primarily affecting adults of both sexes in their third and fourth decades of life. Patients with MD typically present with asymptomatic, recurrent bilateral symmetrical pitting edema, which has an insidious onset and a progressive course. This edema affects the upper two-thirds of the face, including the forehead, glabella, periorbital area, cheeks, and nose, with or without erythema. Over time, it evolves into persistent solid, non-pitting, asymptomatic edema that is neither painful nor pruritic. Morbihan disease may cause facial contour deformity and sometimes narrowing of the visual field. The etiopathogenesis of MD remains unknown, and currently, there is no specific treatment for the condition. This review article provides an update on MD, aiming to increase awareness and knowledge about its etiopathogenesis and management.

Prenatal diagnosis of a severe form of frontonasal dysplasia with severe limb anomalies, hydrocephaly, a hypoplastic corpus callosum, and a ventricular septal defect using 3D ultrasound: a case report and literature review

BackgroundFrontonasal dysplasia (FND) is a rare congenital anomaly resulting from the underdevelopment of the frontonasal process, and it can be syndromic or nonsyndromic. The typical features of FND include a deformed nose and ocular hypertelorism, which are sometimes associated with cleft lip and/or palate. Only approximately 10 cases of prenatally diagnosed nonsyndromic FND have been reported in the past 30 years.Case presentationA 33-year-old woman (G2P1) was referred to our center at 20 gestational weeks for bilateral hydrocephaly. We detected typical features of FND, including severe hypertelorism, median nasal bifidity, a minor cleft lip, and multiple limb anomalies using three-dimensional (3D) ultrasound. A hypoplastic corpus callosum, unilateral microtia, and a ventricular septal defect were also detected. Genetic testing, including karyotype analysis, copy number variation (CNV) analysis, trio-whole exome sequencing (trio-WES), and trio-whole-gene sequencing (trio-WGS), was performed; however, we did not find any de novo gene variants in the fetus as compared to the parents. Postmortem examination confirmed the prenatal diagnosis of FND.ConclusionThe present case expands the wide phenotypic spectrum of prenatal FND patients. 3D ultrasound is a useful tool for detecting facial and limb deformities.

Sinonasal chondrosarcoma in a llama.

A 14-y-old intact female llama (Lama glama) was presented for evaluation of a right maxillary swelling of 3-mo duration. Clinically, the animal had mild nasal discharge, abnormal retropulsion of the right eye, and moderate gingival disease. An incisional biopsy of the maxillary mass revealed pleomorphic and mitotically active neoplastic spindle-to-stellate cells organized in haphazard lacunae embedded in abundant chondroid matrix. Given the poor prognosis, euthanasia was elected. Postmortem examination and sectioning of the head exposed a large solid, white, firm mass that vastly expanded the right infraorbital region, extending to the maxilla, effacing the right nasal conchae and ipsilateral zygomatic bone. Collectively, postmortem dissection, cytology, and histopathology of the primary mass supported a diagnosis of sinonasal chondrosarcoma. To our knowledge, this entity had not been reported previously in this species and should be considered a differential for facial deformities in New World camelids.

Mechanical Behavior of Geogrid Flexible Reinforced Soil Wall Subjected to Dynamic Load

The geogrid flexible reinforced soil wall is widely used in engineering practice. However, a more comprehensive understanding of the dynamic behavior of reinforced soil wall is still required for a more reasonable application. In order to explore the mechanical behavior of a geogrid flexible reinforced soil wall, the model test was carried out to investigate the dynamic deformation of geogrid reinforced soil wall subjected to a repeated load. The numerical simulation was also conducted for comparison and extension with regards to the earth pressure and the reinforcement strain. The change rules for the deformation of the wall face, the vertical earth pressure and the reinforcement strain subjected to dynamic load with four frequencies (4, 6, 8 and 10 Hz) and four amplitudes (30–60, 40–80, 50–100 and 60–120 kPa) were obtained. The factors that affect the mechanical behavior of geogrid flexible reinforced soil wall were analyzed. The results show that the dynamic deformation characteristics of reinforced soil wall are affected by the number of vibrations, the amplitude of dynamic load and the frequency of vibration. The maximum lateral displacement of the reinforced soil wall occurs on the third to the fifth layer. With an increase in dynamic load amplitude, the development of dynamic deformation gradually increases, and after a cumulative vibration of 200 × 104 times, the cumulative lateral deformation ratio and the cumulative vertical deformation ratio of the wall face is less than 1%. The vertical earth pressure of geogrid flexible reinforced soil wall increases partially along the length of the reinforcement, and the vertical earth pressure of the third layer is basically unchanged when subjected to a dynamic load. With an increase in vibration number, the change in the reinforcement strain of the third layer is more complex, and the change rules of the reinforcement strain of each layer are different. The reinforcement strain is small, with a maximum value of 0.1%.

Study on the integration of emergency IPAs in Nord-Pas-de-Calais: supervisors' perspectives

In the context of the introduction of advanced practice nurses in emergency departments (APNs), the Collège de Médecine d'Urgence du Nord-Pas-de-Calais teamed up with the Unité de Formation et de Recherche des Sciences de la Santé et du Sport at the University of Lille to conduct a survey of emergency department management teams, with the aim of gaining a better understanding of their needs. The results revealed a number of obstacles and levers to the implementation of APNs, and led to a better understanding of the patient pathways in these departments. As a result, the content of the university teaching program could be reviewed with a view to meeting the needs expressed in the field.

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

High-grade sinonasal adenocarcinoma as an unusual presentation: A case report

The occurrence of malignant tumors, such as adenocarcinoma, is commonplace in the nasal region, characterized by a notably low incidence. This rarity often contributes to delayed diagnosis, rendering the condition challenging to manage. Here, we present the case of a 70-year-old man who presented with chronic left nasal obstruction, accompanied by headaches and recurrent epistaxis. The diagnostic investigation revealed an extensive and aggressive nasal adenocarcinoma, necessitating a hemi-maxillectomy for tumor excision. Subsequent reconstruction of the ipsilateral cheek was accomplished using a pectoralis major flap. Despite the initial intervention, the patient experienced a recurrence 1 year later. In sinonasal adenocarcinoma, nasal obstruction stands out as the predominant symptom, complemented by potential manifestations of swelling and facial deformation. The inherently aggressive nature of this tumor underscores the imperative for early diagnosis and meticulous management to achieve optimal therapeutic outcomes. The comprehensive approach involving surgical intervention and reconstruction reflects the complexity in treating advanced nasal adenocarcinomas.

Anesthetic management of a high-risk patient with complex medical conditions: A case report of multimodal analgesia and regional nerve blocks in urgent transfemoral amputation

This case article presents the anesthetic management of a patient with complex medical conditions and surgical requirements. The patient had secondary hyperparathyroidism due to chronic renal failure, resulting in hypocalcemia. The patient required a transfemoral amputation due to progressive bacterial infection and global foot gangrene. The urgency of the operation prevented preoperative preparation and necessitated careful consideration of the patient's cardiovascular and respiratory challenges. Due to the patient's facial deformity and limited neck mobility, general anesthesia was not feasible. Instead, a multimodal analgesia approach was adopted, utilizing regional nerve blocks targeting various nerves involved in lower limb innervation. This approach, combined with sedation, provided effective surgical anesthesia.

Computerized Surgical Planning in Face Transplantation.

Face transplantation (FT) has emerged as a critical intervention for patients with complex facial deformities unsuitable for conventional reconstructive methods. It aims to restore essential functions such as facial expression, mastication, and speech, while also improving psychosocial health. The procedure utilizes various surgical principles, addressing unique challenges of craniofacial complexity and diverse injury patterns. The integration of Computerized Surgical Planning (CSP) leverages computer-aided technologies to enhance preoperative strategy, intraoperative navigation, and postoperative assessment. CSP utilizes three-dimensional computed tomography, printing, angiography, and navigation systems, enabling surgeons to anticipate challenges and reduce intraoperative trial and error. Through four clinical cases, including a groundbreaking combined face and bilateral hand transplant, CSP's role in FT is highlighted by its ability to streamline operative processes and minimize surgical revisions. The adoption of CSP has led to fewer cadaveric rehearsals, heightened operative precision, and greater alignment with preoperative plans. Despite CSP's advancements, it remains complementary to, rather than a replacement for, clinical expertise. The demand for technological resources and multidisciplinary teamwork is high, but the improved surgical outcomes and patient quality of life affirm CSP's value in FT. The technology has become a staple in reconstructive surgery, signaling a step forward in the evolution of complex surgical interventions.

Granulomatosis With Polyangiitis (Wegener's Granulomatosis) Nasal Reconstruction: Improved Outcomes With No Delay.

Granulomatosis with polyangiitis (Wegener's granulomatosis) causes progressive nasal collapse, nasal obstruction, and central face deformity. It is not known whether cartilaginous nasal reconstruction should be performed immediately or delayed until after disease "burnout." The aims of this research regarding nasal collapse due to Wegener's granulomatosis were to (1) assess the functional and aesthetic outcomes following immediate vs delayed nasal reconstruction; and (2) measure the impact of psychosocial well-being (anxiety, depression, social isolation) in immediate vs delayed nasal reconstruction. Wegener's patients with either immediate or delayed nasal surgery (n = 61) were compared. Functional and aesthetic severity were compared with the validated Standard Cosmesis and Health Nasal Outcome Survey (SCHNOS) score (t test). In addition, Patient-Reported Outcomes Measurement Information System (PROMIS) perioperative and 1-year follow-up surveys were analyzed. At initial consultation, SCHNOS score severity types were similar for both groups (immediate vs delayed): mild 15% vs 15%; moderate 59% vs 60%, and severe 26% vs 25%. Over a 30 ± 4 month period, delayed surgery patients' conditions deteriorated, with a shift from mild to more severe SCHNOS scores, from 25% severe at initial consultation to 85% before surgery. PROMIS scores at presentation were high compared to the general public; by the time of delayed surgery, patients had significantly worsened: anxiety from 28 to 73; depression from 18 to 62; and social isolation from 20 to 80. Although both immediate and delayed groups improved after surgery in functional and psychosocial scores, the immediate surgery group's improvement was superior. Data showed superior functional and aesthetic scores and superior psychosocial indicators with immediate cartilaginous nasal reconstruction, compared with waiting until disease burnout to undergo surgery.

Automatic extraction of facial median sagittal plane for patients with asymmetry based on the EDMA alignment algorithm.

We aimed to establish a novel method for automatically constructing three-dimensional (3D) median sagittal plane (MSP) for mandibular deviation patients, which can increase the efficiency of aesthetic evaluating treatment progress. We developed a Euclidean weighted Procrustes analysis (EWPA) algorithm for extracting 3D facial MSP based on the Euclidean distance matrix analysis, automatically assigning weight to facial anatomical landmarks. Forty patients with mandibular deviation were recruited, and the Procrustes analysis (PA) algorithm based on the original mirror alignment and EWPA algorithm developed in this study were used to construct the MSP of each facial model of the patient as experimental groups 1 and 2, respectively. The expert-defined regional iterative closest point algorithm was used to construct the MSP as the reference group. The angle errors of the two experimental groups were compared to those of the reference group to evaluate their clinical suitability. The angle errors of the MSP constructed by the two EWPA and PA algorithms for the 40 patients were 1.39 ± 0.85°, 1.39 ± 0.78°, and 1.91 ± 0.80°, respectively. The two EWPA algorithms performed best in patients with moderate facial asymmetry, and in patients with severe facial asymmetry, the angle error was below 2°, which was a significant improvement over the PA algorithm. The clinical application of the EWPA algorithm based on 3D facial morphological analysis for constructing a 3D facial MSP for patients with mandibular deviated facial asymmetry deformity showed a significant improvement over the conventional PA algorithm and achieved the effect of a dental clinical expert-level diagnostic strategy.

A comparative analysis of 3D woven honeycomb-based aircrew helmet liners against Nomex and Aluminum alternatives

This study investigates the energy dissipation efficiency of an aircrew helmet liner developed using 3D woven honeycomb structural composites compared to different commercially available honeycomb liner materials such as Nomex, and Aluminium. In contrast to liners with discrete density differences, the use of a honeycomb-based liner reduces the concern about delamination, back face deformation and fracture propagation. The research involves comparing several parameters related to crashworthiness, such as specific energy absorption (SEA), crush force efficiency (CFE), and margin of safety, which are crucial for head protection and ensuring helmet injury tolerance. These parameters play a vital role in assessing the ability of different configurations of the honeycomb liner during impacts. Flatwise compression and dynamic impact tests were conducted to evaluate the helmet liner’s performance while maintaining consistency in the helmet shell component. Finite element analysis (FEA) and 3D x-ray Tomography techniques were utilized to analyse the back face deformation (BFD) at high-velocity impact and the internal damage resulting from impacts on the helmet liners, respectively. The results revealed that the 3D woven honeycomb liner configuration performs optimally in terms of energy absorption by demonstrating sufficient and balanced competency across these three critical factors. Additionally, the simulation result revealed that the 3D woven honeycomb liner exhibits wave propagation. This phenomenon enhances its energy absorption capacity and reduces back-face deformation attributed to its crushing behaviour. This research offers valuable insights for improving the performance of aircrew helmet liners, with a particular focus on utilizing 3D woven honeycomb liners featuring 3D woven solid structure to maintain exceptional structural integrity.

Management of complete intra-articular distal femur and patellar fractures in an achondroplastic young adult; small is challenging’ revisited: a case-report

BackgroundPeople with achondroplasia exhibit distinct physical characteristics, but their cognitive abilities remain within the normal range. The challenges encountered during surgical procedures and perioperative care for achondroplastic individuals, are underrepresented in the existing literature.Case presentationIn this report, the management of a 26-year-old North-African achondroplastic male is highlighted. The patient suffered a complete intra-articular distal femur fracture (AO/OTA 33-C1) and an ipsilateral patella fracture (AO/OTA 34-C1). The patient’s unusual anatomical variations and the lack of suitable orthopedic implants posed significant surgical challenges, particularly in the context of a resource-limited developing country. Facial and spinal deformities, which are common in patients with achondroplasia, further complicated the anesthetic approach.ConclusionsThe limited information on operative management of fractures in achondroplastic patients necessitated independent decision-making and diverging from the convenient approach where clear guidance is available in the literature.

Cranial Nerve Injuries in Orthognathic Surgery: A Review of Literature.

Orthognathic surgery is increasingly utilized to correct facial deformities and dental malocclusions, as well as to enhance facial aesthetics. Significant advancements in surgical planning and execution have made it more widespread and accessible. However, unfavorable outcomes or complications can occur, leading to potentially severe and possibly long-term consequences, such as cranial nerve injuries. This literature review investigates the cranial nerve complications associated with orthognathic surgery. We conducted an extensive search across available databases, analyzing relevant studies published up to September 30, 2023. Two authors independently selected articles for full-text review based on their titles and abstracts. The eligible studies reported cranial nerve injuries in individuals who had undergone orthognathic surgery. Our findings highlight the risk of cranial nerve injuries, their possible mechanism, management, and outcomes. It is imperative for surgeons to remain vigilant and informed and to communicate such information during preoperative patient consultation.

Photographic Parameters in Three-Dimensional Facial Image Acquisition. A Scoping Review.

Orthognathic surgery is a viable and reproducible treatment for facial deformities. Despite the precision of the skeletal planning of surgical procedures, there is little information about the relations between hard and soft tissues in three-dimensional (3D) analysis, resulting in unpredictable soft tissue outcomes. Three-dimensional photography is a viable tool for soft tissue analysis because it is easy to use, has wide availability, low cost, and is harmless. This review aims to establish parameters for acquiring consistent and reproducible 3D facial images. A scoping review was conducted across PubMed, SCOPUS, Scientific Electronic Library Online (SciELO), and Web of Science databases, adhering to "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews" guidelines. Articles presenting 3D facial photographs in the diagnostic phase were considered. A total of 79 articles were identified, of which 29 were selected for analysis. The predominant use of automated systems like 3dMD and VECTRA M3 was noted. User positioning has highest agreement among authors. Noteworthy aspects include the importance of proper lighting, facial expression, and dental positioning, with observed discrepancies and inconsistencies among authors. Finally, the authors proposed a 3D image acquisition protocol based on this research findings.

A COMPARATIVE STUDY ON NASAL BONE FRACTURE ASSOCIATED WITH SEPTAL DEVIATION CORRECTED WITH SEPTOPLASTY VERSUS CLOSED REDUCTION

Objective: The dorsum of the nose formed by nasal bones helps to maintain the airway and esthetic appearance of the nose. Faciomaxillary trauma is associated with a nasal bone fracture with or without nasal septal fractures. Nasal bone fractures can lead to deviation of the external nose and nasal obstruction. The management includes correction of nasal bone deformity with either septoplasty or reduction of nasal septal deviation by the non-surgical method. A study was conducted to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction.The aim of this study was to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction. Materials: Sixty-two patients with nasal bone fractures with varying degrees of external nose deformity and nasal septal deviation were divided into two groups. Group A consisted of patients treated with septoplasty and nasal bone fracture correction and Group B consisted of patients treated with non-surgical reduction of septal deviation and nasal bone fracture correction. Type I, II, and II nasal bone fractures were included with all types of septal deviations. The subjective improvement in nasal obstruction was assessed using the visual analog scale in both groups. Results: There were 26 males (81.25%) and 06 (18.75%) females in Group A and 25 (83.33%) males and 05 (16.67%) females in Group B. In Group A, 12 (37.5%) patients were aged between 18 and 27 years, 10 (31.25%) patients were aged between 28 and 27 years, 07 (21.87%) patients were aged between 38 and 47 years, and 03 (09.37%) patients were aged between 48 and 57 years. The mean age was 23.54±2.30 years. Conclusion: Nasal bone fractures cause not only esthetic facial deformity but also functional airway obstruction. A thorough clinical examination, computed tomography scan, and patient counseling are necessary. There is no statistically significant difference in the final outcome between the septoplasty and closed reduction of the septal deviation undertaken to relieve nasal obstruction in patients with associated nasal bone fractures.

Numerical and experimental investigations into the ballistic mechanism of 3D through-the-thickness angle interlock woven fabric

High-performance 3D fabrics have great potential for ballistic protection. This study investigated the ballistic behavior of 3D through-the-thickness angle-interlock woven fabrics (3DTAWF) under the impact of Full Metal Jacket (FMJ) projectiles. A finite element analysis (FEA) of the interaction process of para-aramid Twaron 3DTAWF against a 9 mm bullet was performed in LS-DYNA by considering actual geometries and deformability of the interacting parts. A full-size mesoscale fabric structure model was constructed to capture the ballistic behavior of 3DTAWF accurately. The strain rate effect material model was used to improve computational accuracy. The impact performance was evaluated by analyzing the energy loss of the projectile, back face deformation, and residual velocity for penetrating impact tests. The results revealed the impact damage evolution, energy absorption mechanism, and stress wave distribution in the 3DTAWF. The main goal of this study was to develop a full-size mesoscale fabric model suitable for the simulation of the ballistic interaction of 3DTAWF of actual dimensions using moderate computer resources and satisfactory adequacy. The model is instructive for the 3D fabric design and development for ballistic protection.

Cochlear implantation through retro-facial approach with congenital microtia malformation with facial nerve deformity: a case report

The difficulty of cochlear implantation in patients with congenital microtia is usually increased due to the vague anatomical marks and facial nerve malformation. The common types of facial nerve malformation include facial nerve bony cover loss, aberrant position, and bifurcation malformation. Bifurcation malformation may obscure the oval window, press against stapes, and bifurcate in the vestibular window while obscuring the round window. It is important to correctly identify the facial nerve and choose a reasonable surgical approach to avoid postoperative complications. This article describes a case of profound sensorineural hearing loss due to facial nerve malformation in our institution. The patient underwent cochlear implantation through the retro-facial approach. There was no facial nerve injury or dysfunction symptoms such as facial paralysis and hemifacial spasm 2 years after the operation, and the cochlear implant works well. The score of the categories of the auditory performance（CAP） questionnaire was 7, and the score of the speech intelligibility rating（SIR） questionnaire was 4. When the round window cannot be exposed through the facial recess approach during surgery, the retro-facial approach is a feasible method. To avoid facial nerve injury, a thin-section CT of the temporal bone should be performed before the middle and inner ear surgery for patients with facial nerve malformation, and the intraoperative facial nerve monitor should be used to clarify the course of the facial nerve to avoid injury.

Functional and Esthetic Outcomes of Either Surgically or Conservatively Treated Anterior Frontal Sinus Wall Fractures: A Long-Term Follow-Up

Study Design Retrospective cohort study. Objective Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical or conservative, remains a topic of ongoing discussion. The aim of this study was to evaluate and compare the functional and esthetic outcomes of patients with surgically and conservatively treated FSFs. Methods In this retrospective study, patients treated for FSFs at the Karolinska university hospital 2004 to 2020 were identified in hospital records and invited to participate in a long-term follow-up. Sequelae and satisfaction with the esthetic result were assessed trough questionnaires and physical examinations. Results A total of 93 patients were included in the study, with 49 presenting isolated anterior wall fractures and 44 presenting combined anterior and posterior wall fractures. Surgical intervention was performed in 45 cases, while 48 were managed conservatively. Among patients with moderate anterior wall fractures (4-6 mm dislocation), 80% of surgically treated patients compared to 100% of conservatively treated patients expressed satisfaction with their cosmetic outcomes at follow-up ( P = .03). In conservatively treated patients with a forehead impression, the anterior wall fracture dislocation ranged from 5.3 to 6.0 mm ( P < .0001). Approximately 50% of surgically treated patients vs 15% of conservatively treated patients developed impaired forehead sensation at follow-up ( P = .03). Thirty-six percent of surgically treated patients reported dissatisfaction with surgery-related scarring, particularly those who underwent surgery via laceration or bicoronal incision. Conclusions This study suggests that anterior FSFs with a dislocation of 5 mm or less can be effectively managed conservatively with high patient satisfaction, low risk of long-term forehead sensation impairment and without potential development of forehead impression. Bicoronal incision or incision via a laceration may be associated with esthetic dissatisfaction and late sequelae such as alopecia.

A design model of multi-layer modified aramid fabrics against fragment simulating projectiles and full metal jacketed bullets

Soft body armor is required to meet threats of both bullets and explosion fragments in battlefield. However, designing body armor that can protect against these two types of projectiles considering both critical velocity and back face deformation (BFD) is often based on experience and extensive ballistic experiments. This paper proposes a quick design model for determining the layers of aramid fabrics modified by polyethylene (PE) to protect against fragment simulating projectiles (FSP) and full metal jacketed bullets (FMJ). Firstly, ballistic experiments are conducted discovering the optimal concentration of PE modification against the sphere and FSP is 10 %. Secondly, finite element model is adapted to explore the protection capabilities of modified aramid fabrics against FSP and FMJ and a linear relationship between the BFD and the critical velocity has been observed. Thirdly, an analytical model is established to uncover the reason of this relationship. Finally, a design model is proposed to configure the improved outer tactical vest (IOTV) generation III based on the derived formulae of critical velocity and BFD for different layers of modified aramid fabrics against FSP and FMJ. The model indicates that the objectives of intercepting FSP or FMJ and reducing blunt trauma are usually not simultaneously attainable. 38 layers of modified aramid fabrics are sufficient to meet the protection requirements for both FSP and FMJ, regardless of critical velocity and BFD. Besides, 498 m/s is the threshold of FMJ impact velocity to determine the priority of intercepting bullets or reducing blunt trauma. The design model can serve for the development of lightweight and effective body armor.