Results Of Reconstruction Research Articles

Comparative Analysis of Surgical Outcomes in Separation Surgery vs. Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression

Study Design. Retrospectively matched case-control study Objective. To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC). Summary of Background Data. The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods. Methods. Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion and complications. The Mann-Whitney U test was used for continuous data, and Fisher’s exact test for categorical data. Results. Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss (median 500 ml [IQR 300-1,000] vs. 925 ml [IQR 500-1,425]; P=0.036) and shorter operating times (median 214 minutes [IQR 164-281] vs. 286 minutes [IQR 220-328]; P=0.028). Intraoperative blood transfusion occurred in seven patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group (P=0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative transfusions, reoperations, or survival (P<0.05). Conclusion. Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control. Level of evidence: Treatment benefits, Level IV

Contemporary role of the plastic and reconstructive surgeon in the outcome of female peripelvic defects after oncologic extirpation.

Reconstruction of female oncologic peripelvic defects is challenging due to complex anatomy, neoadjuvant chemoradiation, operative resection margins, and wound healing risks. Functional restoration requires thoughtful management focused on defect reconstruction and patient-reported outcomes. A retrospective chart review of peripelvic reconstruction in female patients at MD Anderson Cancer Center from 2016 to 2023. Data collected included the patient'scomorbidities, tumor characteristics, and reconstructive details. Complications were classified as nonoperative or operative within 30 days. Patient outcomes included hernia rates, sexual activity, and revision needs. In the study period, 164 patients underwent peripelvic defect reconstruction. Most had colorectal (57%), anal (17%), or gynecologic malignancies (10%). 83% had prior radiation. 33.3% had Class II or III obesity. The most common resection was open colorectal resection with partial vaginectomy (66%). Pedicled flaps (93%) were frequently used, mainly vertical rectus abdominis muscle (65%) and gracilis (11%). For multi-visceral resections, abdominal-based flaps were used in 95% of open casesand thigh-based flaps in 88.9% of robotic cases. 51% had formal abdominal wall repair. Complications occurred in 47%, with 9.1% needing surgery. Postoperative hernias were reported in 4.9%, with 3% requiring repair. Approximately 11% reported being sexually active at the last follow-up. Of those instructed on vaginal dilator therapy (42%), 24.6% were sexually active. Peri-pelvic soft tissue reconstruction in the oncologic population is safe. Operative complications and hernia rates are low. In robotic surgery, thigh-based flaps are increasingly used to reconstruct the peripelvic region. Return to sexual activity is higher in patients when given dilator therapy instruction.

Reconstruction of flame permittivity distribution based on ECT and Lp regularized D-bar method

Abstract The measurement of flame permittivity is significant in obtaining the combustion state. A method of Lp regularized D-bar is proposed in this article, which is used to reconstruct flame permittivity distribution by electrical capacitance tomography (ECT). Firstly, the distribution characteristic of flame permittivity is analyzed using the electric probe method. The simulation model of ECT flame measurement is set up based on the result of flame permittivity distribution. Then, the relationship model between the truncation radius of the D-bar algorithm and noise level is fitted based on the simulation reconstruction results of flame permittivity. The truncation radius of the D-bar algorithm for flame permittivity reconstruction is obtained by the relationship model. The Lp regularization is introduced into the scattering transformation solving of the D-bar algorithm, and the simulation results of flame permittivity reconstruction under different p-values are compared. In the experiment, the reconstruction of flame permittivity by the D-bar algorithm with different truncation radii is compared. The experimental results verify the truncation radius strategy based on noise level. Moreover, compared with L 1 and L 2 regularization methods, Lp regularization combined with the D-bar algorithm is more accurate in the experiment results of flame permittivity reconstruction.

Comparison of Short-Term Clinical Effects of Minimally Invasive Anterior Talofibular Ligament Reconstruction versus Suture Anchor Repair for Chronic Lateral Ankle Instability

Objective: To compare the short-term clinical effects of minimally invasive anterior talofibular ligament (ATFL) reconstruction versus suture anchor repair in patients with chronic lateral ankle instability. Methods: A retrospective analysis was conducted on 68 patients at the 960th Hospital of the Chinese People’s Liberation Army Joint Logistics Support Force between January 2022 and June 2023, patients were divided into two groups based on surgical procedure: Group A (ATFL reconstruction, 35 cases) and Group B (suture anchor repair, 33 cases). Follow-up ranged from 1 to 12 months, assessing the American Orthopaedic Foot and Ankle Society (AOFAS) score, VAS pain score, Tegner activity score, and patient satisfaction, while noting any recurrence of ankle instability or complications such as numbness or infection. Results: In Group A, the AOFAS score improved from 74.46 ± 2.96 preoperatively to 90.91 ± 2.79 at final follow-up, Tegner score from 2.40 ± 0.50 to 5.69 ± 0.76, and VAS from 3.14 ± 0.85 to 1.60 ± 0.50; patient satisfaction was 8.31 ± 0.72. In Group B, AOFAS improved from 74.48 ± 2.29 to 90.55 ± 3.12, Tegner from 2.48 ± 0.51 to 5.76 ± 0.79, and VAS from 3.45 ± 0.83 to 1.73 ± 0.50, with patient satisfaction at 8.27 ± 0.63. No significant statistical difference was found between groups in any score (P > 0.05), with both groups showing significant postoperative improvement (P < 0.05) and no serious complications within 1-year follow-up. Conclusion: Both ATFL reconstruction and suture anchor repair yield favorable short-term outcomes in treating lateral ankle instability. Further research is needed to assess if anatomical reconstruction offers superior biomechanical benefits in scar healing over the suture anchor repair in long-term follow-up.

Biomechanical evaluation of implant options for unilateral maxillary defects: a finite element analysis

ObjectiveThis study aimed to evaluate stress distribution in unilateral maxillary defects using finite element analysis (FEA) to compare subperiosteal (SI) and zygomatic implants (ZI).Materials and methodsA 3D model of a unilaterally atrophied maxilla was reconstructed from CT scans. Five scenarios were simulated: (1) quad zygoma implants (SC1), (2) zygoma and conventional implants (SC2), (3) two-piece SI and conventional implants (SC3), (4) one-piece SI and conventional implants (SC4) and (5) one-piece SI implant (SC5). Mechanical properties were assigned based on data in the literature; a 450 N force for occlusal loading and a 93 N force for oblique loads were applied.ResultsUnder vertical loading, SC2 exhibited the highest tensile stress (Pmax) in the atrophic region (R-AM), while SC4 showed the lowest Pmax across the entire maxilla, indicating better stress distribution. Under oblique forces, SC2 also showed the highest Pmax in R-AM, while SC5 had the lowest Pmax overall. Minimum principal stress (Pmin) followed similar patterns, with SC4 and SC5 demonstrating lower stress levels than the other scenarios. Abutment stresses were highest in SC2 and lowest in SC4. Overall, the SI scenarios (SC3–SC5) exhibited lower stress transmission to the alveolar bone than the ZI scenarios (SC1 and SC2), with SC4 providing the most balanced stress distribution across all regions.ConclusionsSI implants, mainly the one-piece SI (SC4), offered a more favourable stress distribution than ZI implants in unilateral maxillary defects, reducing the risk of excessive bone stress. This finding suggests that SI implants may be superior for such cases, although individual patient anatomy should guide implant selection. Further clinical studies are necessary to confirm these biomechanical findings in vivo.Clinical relevanceThis study underscores the crucial role of implant selection in minimising stress on the alveolar bone in unilateral maxillary defects. Based on these findings, we recommend personalised implant strategies based on biomechanical insights to enhance outcomes in maxillofacial reconstruction.

The Impact of Complication Timing on the Outcomes of Implant-based Breast Reconstruction

Background: The National Surgical Quality Improvement Program (NSQIP) database provides an important resource for determining complication rates and risk factors for surgical procedures. However, NSQIP is limited to 30-day follow-up, and it is unclear whether this is reliable for evaluating prosthetic breast reconstruction outcomes. Methods: A single-institution, cross-sectional, retrospective review was performed for patients undergoing mastectomy with immediate, prepectoral tissue expander reconstruction. Timing of complications was stratified as early (within 30 days of operation) versus late (after 30 days). Categorical variables were compared using χ2 (or Fisher exact) tests, and continuous variables were analyzed using Kruskal-Wallis or Wilcoxon rank-sum tests. Results: There were 301 patients (509 reconstructed breasts) included with a median follow-up time of 11 months. Of them, 176 patients (58%) experienced a postoperative complication—140 patients (47%) experienced an early complication and 36 patients (12%) experienced a late complication. Patients with late complications had a significantly higher rate of reconstructive failure compared with the early complication group (17% versus 10%; P = 0.001) and were more likely to require a flap (28% versus 7%; P = 0.001) for final reconstruction. Revision surgery rates after final implant placement were higher in the late complication group (36% versus 64%; P = 0.285). Conclusions: Late complications after prepectoral breast reconstruction have a more prominent impact on reconstructive failure and revisions than early complications. This finding may inform strategies to revise national databases such as NSQIP to include more detailed information and longer capture periods.

Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post-Burn Deformities and Achieving Optimal Reconstruction Outcomes.

Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk. Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree-linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction. Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58. Three-dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.

Investigating the Impact of the Regularization Parameter on EEG Resting-State Source Reconstruction and Functional Connectivity Using Real and Simulated Data

Accurate EEG source localization is crucial for mapping resting-state network dynamics and it plays a key role in estimating source-level functional connectivity. However, EEG source estimation techniques encounter numerous methodological challenges, with a key one being the selection of the regularization parameter in minimum norm estimation. This choice is particularly intricate because the optimal amount of regularization for EEG source estimation may not align with the requirements of EEG connectivityanalysis, highlighting a nuanced trade-off. In this study, we employed a methodological approach to determine the optimal regularization coefficient that yields the most effective reconstruction outcomes across all simulations involving varying signal-to-noise ratios for synthetic EEG signals. To this aim, we considered three resting state networks: the Motor Network, the Visual Network, and the Dorsal Attention Network. The performance was assessed using three metrics, at different regularization parameters: the Region Localization Error, source extension, and source fragmentation. The results were validated using real functional connectivity data. We show that the best estimate of functional connectivity is obtained using 10−2, while 10−1 has to be preferred when source localization only is at target.

Domain sampling methods for an inverse boundary value problem of the heat equation

Abstract We investigate the reconstruction of an unknown cavity inside a heat conductor with only single boundary measurement, which is a typical non-destructive testing of defects in material science using thermography. Mathematically, it can be formulated as an inverse boundary value problem for the heat equation. Two domain sampling methods, i.e., the range test (RT) and no-response test (NRT), are developed to realize the reconstruction. We first justify the convergence of the RT, which is based on the analytical extension property of solutions to the heat equation. Then we prove the duality of the RT and NRT by looking at the relation between their indicator functions. Consequently, the unknown cavity can be reconstructed by using either the RT or NRT if the solution associated to the single measurement cannot be analytically extended across its boundary. Next, we design two efficient algorithms for the RT and NRT to reconstruct the unknown cavity numerically. Each algorithm consists of two steps. The first step is to determine an approximation of the unknown cavity by implementing the sampling methods in a coarse grid, while the second step is to improve the reconstruction by using a fine grid in the approximate domain. The numerical results suggest that both algorithms can generate some rough information on the cavity with only one boundary measurement. Finally, by using this information as an initial guess for Newton's method, we improve the accuracy of the mentioned reconstruction results.

Alveolar Bone Reconstruction Simultaneous to Implant Removal due to Advanced Peri-Implantitis Defects: A Proof of Concept.

To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis. Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥ 50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose cross-linked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes. In total, 20 patients (nimplant = 39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants. The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

Simulation study on magneto-acoustic concentration tomography of magnetic nanoparticles based on vectorial acoustic source and BICGSTAB method

Abstract To overcome the vulnerability to noise of the reconstructed image and simplify the cumbersome iteration process of algorithm in the magneto-acoustic concentration tomography with magnetic induction (MACT-MI) for magnetic nanoparticles (MNPs), we established the matrix relationship between the concentration of MNPs and the first-order derivative of sound pressure based on the reconstruction method of vectorial acoustic source, and proposed the application of BICGSTAB method in solving the concentration distribution. Firstly, a simulation model was established in COMSOL Multiphysics. Secondly, the obtained data were substituted into the derived formula for imaging reconstruction. Finally, the quality of the reconstructed image was analyzed. The effects of MNP radius, shape, asymptotic concentration, and SNR on the reconstruction results were studied. Simulation results show that under the same noise condition, compared with the reconstruction method based on the LSQR-trapezoidal method, the average correlation coefficient increased by 32.9%, the average relative error decreased by 48.5%, the average structural similarity increased by 48.2%, and the average iterations decreased by 58.5%. The proposed method shows superior imaging quality and noise immunity. The research provides a theoretical basis for subsequent experimental research.

Phase synthesis method in multi-aperture optical systems based on iterative image processing algorithms

Background. Modern technologies in the field of optics and photonics place high demands on the quality and output power of the radiation source. The fulfillment of these requirements can currently be achieved by creating multi-aperture laser systems with coherent beam addition. The main problem of creating such systems is the development of phase synthesis methods in a multichannel optical system. Aim. In this paper, we consider a phase synchronization method without a reference beam for a coherent addition system with active feedback, which is based on the Gerchberg–Saxton algorithm. This algorithm makes it possible to reconstruct complex field amplitudes in the aperture and focal planes from intensity distributions in these fields. The application of this algorithm for multichannel systems is analyzed and its features, such as the occurrence of stagnation and ambiguity of the solution, are revealed. Methods. Solutions are proposed to eliminate the problem of convergence of the algorithm to side solutions and getting the iterative procedure into the local extremum using global optimization algorithms, methods of reducing the dimension of the problem and the introduction of antisymmetric amplitude modulation. Results. The paper demonstrates the results of phase field reconstruction for a large number of optical sources. For a seven-aperture system, a physical simulation was performed to restore phase information, confirming the results of numerical modeling. Conclusion. The proposed approach is a reasonable alternative to currently existing methods and can be used in the problem of coherent addition in multichannel optical systems.

Enhanced Multi-Scale Attention-Driven 3D Human Reconstruction from Single Image

Due to the inherent limitations of a single viewpoint, reconstructing 3D human meshes from a single image has long been a challenging task. While deep learning networks enable us to approximate the shape of unseen sides, capturing the texture details of the non-visible side remains difficult with just one image. Traditional methods utilize Generative Adversarial Networks (GANs) to predict the normal maps of the non-visible side, thereby inferring detailed textures and wrinkles on the model’s surface. However, we have identified challenges with existing normal prediction networks when dealing with complex scenes, such as a lack of focus on local features and insufficient modeling of spatial relationships.To address these challenges, we introduce EMAR—Enhanced Multi-scale Attention-Driven Single-Image 3D Human Reconstruction. This approach incorporates a novel Enhanced Multi-Scale Attention (EMSA) mechanism, which excels at capturing intricate features and global relationships in complex scenes. EMSA surpasses traditional single-scale attention mechanisms by adaptively adjusting the weights between features, enabling the network to more effectively leverage information across various scales. Furthermore, we have improved the feature fusion method to better integrate representations from different scales. This enhanced feature fusion allows the network to more comprehensively understand both fine details and global structures within the image. Finally, we have designed a hybrid loss function tailored to the introduced attention mechanism and feature fusion method, optimizing the network’s training process and enhancing the quality of reconstruction results. Our network demonstrates significant improvements in performance for 3D human model reconstruction. Experimental results show that our method exhibits greater robustness to challenging poses compared to traditional single-scale approaches.

Comparative study of the outcomes of one-stage versus two-stage reconstruction of chronic multiligament knee injury

BackgroundMulti-ligament knee injury (MLKI) is a complex orthopaedic knee problem, usually following traumatic knee dislocation. Surgical management is preferred and has resulted in better clinical outcomes. However, the optimal surgical treatment protocol is continuously evolving. This study aimed to compare the outcomes of one-stage versus two-stage reconstruction of MLKI. Materials and methodsThis retrospective comparative study was conducted between July 2020 and December 2023 at a government orthopaedic hospital in Nigeria. The inclusion criteria include males and females between 18 and 45 years of age who had one- or two staged knee reconstructions for MLKI and were followed up for a minimum of 12 months. The exclusion criteria were patients below 18 and above 45 years of age, those with previous knee surgery, those associated with femoral or tibia fractures, those with radiological evidence of osteoarthritis, and those with follow-ups less than 12 months. Clinical outcomes using the Lysholm scoring system and complication rate were recorded. The statistical analysis was performed using SPSS version 23. ResultsFifty-one patients (26 in the OS group and 25 in the TS group) were studied. There was a significant difference between the preoperative and postoperative Lysholm scores in the two groups (p = 0.86 and 0.57 for OS and TS, respectively). However, there was no significant difference between the postoperative Lysholm scores in the two groups (p = 0.918). ConclusionOne-stage and two-stage reconstruction of chronic MLKI give similar excellent clinical outcomes.

Discussion: Surgical Outcomes of Vertical Rectus Abdominis Myocutaneous Flap Pelvic Reconstruction.

Discussion: Surgical Outcomes of Vertical Rectus Abdominis Myocutaneous Flap Pelvic Reconstruction.

Functional Assessment of Anterior Cruciate Ligament Reconstruction Using Peroneus Longus vs. Hamstring Tendon at 6, 12, And 24 Months Follow Up: A Meta-Analysis

Background: Anterior cruciate ligament (ACL) tear occurs between 29 to 38 cases per 100.000 people annually with more than half of cases requiring an ACL reconstruction. Peroneus longus tendon (PLT) has growing popularity as an autograft for ACL reconstruction providing comparable outcomes with proper graft diameter size, lack of donor site morbidity and uncomplicated harvesting technique. Unfortunately, certain studies did not agree with the superiority of PLT to the standard hamstring tendon (HT). Objective: The aim of study is to compare the knee functional outcome of an ACL reconstruction using peroneus longus and hamstring tendon according to recent publications. Methods: This study conducted a thorough systematic search for relevant scientific reports on multiple medical databases, including PubMed, Embase, and Google Scholar, using a combination of keywords such as "peroneus longus," “hamstring tendon,” "ACL reconstruction," “IKDC,” and “Lysholm”. The search was performed in April 2013-2023, resulting in 1567 studies. Two reviewers (RR, WA) independently screened the abstracts and reference lists, with any discrepancies resolved through consensus, concluding 5 included studies. Results: Five studies are included with a total of 538 patients consisting of 267 patients who underwent ACL reconstruction with PLT and 271 patients who underwent ACL reconstruction with HT. Up to 24 months follow-up, there are equally balanced satisfactory functional outcomes between ACL reconstruction using peroneus longus and hamstring tendon, in terms of IKDC (I2 = 74%; SMD = 0.08 95%CI, -0.21 to 0.38; p = 0.57) and Lysholm score (I2 = 75%; SMD = 0.06 95%CI, -0.27 to 0.39; p = 0.73). Conclusion: ACL reconstruction using the peroneus longus tendon is a safe and effective procedure with excellent short to long term functional outcome of the knee. Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon.

Race and Ethnicity Impacts Patient-Reported Outcomes in Implant-Based Breast Reconstruction.

Addressing social determinants of health is critical in achieving health equity, and of the many determinants, race and ethnicity are key contributors in postmastectomy breast reconstruction. The purpose of this study was to investigate the impact of race and ethnicity on patient-reported outcomes (PROs) after implant-based breast reconstruction (IBBR) and to provide reference values for each cohort. We identified all patients who underwent IBBR between January 2017 and August 2022 and completed the BREAST-Q longitudinally. Race and ethnicity were self-categorized as White, Asian, Black, or Hispanic. Reference values were established. Outcomes of interest were BREAST-Q scores preoperatively, and 6months, 1year, and 2years postoperatively. Generalized estimating equation (GEE) modeling was performed to assess race and ethnicity as independent predictors of BREAST-Q scores. Overall, 3281 patients were included, of whom 2479 (75.6%) were White, 296 (9.0%) were Asian, 239 (7.3%) were Black, and 267 (8.1%) were Hispanic. There were significant differences in Physical Well-being of the Chest at all timepoints; Satisfaction with Breasts and Psychosocial Well-being at preoperative, 6months, and 1year; and in Sexual Well-being at 1year. GEE modeling showed that relative to White patients, Asian subjects scored significantly lower on all BREAST-Q domains, while Black and Hispanic patients scored significantly lower on the Physical Well-being of the Chest domain. Racial and ethnic disparities persist within IBBR, with minority patients scoring lower on the BREAST-Q than White patients. This study suggests that more work is needed to understand and improve these PROs in minority patient populations. Individualized reference values may prove beneficial in assessing outcomes over time.

Management of Frontal Bone Exposure Following Paramedian Forehead Flap for Nasal Reconstruction.

The paramedian forehead flap is renowned for its versatility and can cover a wide range of nasal defect sizes. Most of the literature discussing outcomes of paramedian forehead flap reconstructions focuses on morbidity at the recipient site. Frontal bone exposure resulting from the use of the paramedian forehead flap is a rare but possible complication, especially when periosteum overlying the bone is damaged during surgery or during healing by secondary intention due to desiccation. In this case, a 53-year-old female underwent nasal reconstruction with a paramedian forehead flap for an extensive nasal defect after Mohs surgery and resection of residual basal cell carcinoma. She missed her postoperative follow-up visit, and her frontal bone was noted to be exposed before the division of the pedicle procedure. During the division of the pedicle, the frontal bone was burred, and a bilayer dermal regeneration matrix was applied. She underwent a split-thickness skin grafting from her thigh at 4 weeks. The graft take was 100%, and wound closure was achieved with an acceptable cosmetic outcome. The successful resolution of the complication through innovative surgical interventions highlights the importance of adaptive surgical strategies and thorough postoperative care, aiming to contribute to the existing body of knowledge and improve future clinical practices in reconstructive surgery.

To evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after canal wall down (CWD) mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.

To evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after canal wall down (CWD) mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.

The Stockholm Spinal Cord Uro Study: Changing patterns of urological surgery in a regional prevalence group through 50 years - Outcomes and lessons learned.

To examine the number and types of urological surgical procedures carried out in a regional prevalence population of patients with traumatic spinal cord injury (SCI) during five decades, evaluate objective and patient-reported outcomes and to consider lessons learned for further improvement of surgical treatment in this patient group. In a cross-sectional study of 412 patients with traumatic SCI, one-third had undergone urological surgery through a period of up to 50 years. Data on types of surgery, complications, follow-up and outcomes were collected in a retrospective review of patient files. S-creatinine, S-cystatin-C, renal ultrasound and a questionnaire regarding complications during the preceding year were assembled as part of a yearly follow-up. Descriptive statistics were calculated. Logistic regression was used to determine risk profiles for the incidence of urological surgery. A total of 137 patients had undergone 262 urological surgical interventions. The incidence was highest amongst persons with a cervical-thoracic neurological level of spinal cord lesion and during the first 2 years after SCI. Surgery for urinary stones constituted 29% of all procedures. One-fourth of the patients had undergone 47% of all procedures, notably urinary diversion and ensuing complications, implants and revisions, repeated stone interventions or bladder outlet procedures. After reconstructive surgery functional outcomes and patient-reported satisfaction were generally favourable, but long-term signs of renal complications were frequent. Urological surgery after SCI involves imperative as well as reconstructive procedures, some of which are challenging and call for centralisation to devoted teams. Prospective studies of reconstructive urology are warranted, including more extensive patient-reported outcomes.