Reconstruction Of Defects Research Articles

Surgical Management of Periprosthetic Joint Infections in Hip and Knee Megaprostheses.

Periprosthetic joint infection is a feared complication after the megaprosthetic reconstruction of oncologic and non-oncologic bone defects of including the knee or hip joint. Due to the relative rarity of these procedures, however, optimal management is debatable. Considering the expanding use of megaprostheses in revision arthroplasty and the high revision burden in orthopedic oncology, the risk of PJI is likely to increase over the coming years. In this non-systematic review article, we present and discuss current management options and the associated results focusing on studies from the last 15 years and studies from dedicated centers or study groups. The indication, surgical details and results in controlling infection are presented for debridement, antibiotics, irrigation and retention (DAIR) procedure with an exchange of the modular components, single-stage implant exchange, two-stage exchanges and ablative procedures.

CLINICAL AND RADIOGRAPHIC ASSESSMENT OF BOND APATITE IN HORIZONTAL BONE AUGMENTATION AROUND DENTAL IMPLANTS: A RANDOMIZED CONTROLLED TRIAL

Background:Bond apatite is a composite graft, composed of two-thirds biphasic calcium sulfate and one-third hydroxyapatite granules of various sizes and shapes. Oral implants are used to secure dental prostheses in cases of partial or total edentulism. The outcomes of correctly completed dental-implant procedures result in high rates of success and survival of dental prostheses. Objective:The aim of this study was to assess Bond Apatite use in horizontal bone augmentation around dental implants, clinically and radiographically. Materials and Methods:This research included sixteen patients, six men and ten women, with an average age of thirty years having missing maxillary anterior or premolar teeth with insufficient horizontal bone. The patients were divided into two groups: group I patients (N=8) received dental implants with Bond apatite, while group II patients (N=8) received dental implants with Bio-Oss bone graft material and pericardium bioresorbable membranes. All patients were evaluated clinically usingthe modified plaque index (MPI), modified gingival index (MGI) and probing depth (PD) and radiographically to assess bone width dimensions. Results: There was a statistically significant difference between groups regarding MGI(p = 0.038)andperi-implant buccal PD [mm](p = 0.026). There was no statistically significant difference between the tested groups regarding age(p = 0.608), sex(p = 0.123), MPI(p = 0.608),orperi-implant palatalPD [mm](p = 0.118). There was no statistically significant difference between the two groups regarding postoperative bone width (p = 0.187). Conclusion:Bond apatitemay be used as one of the materials of choice for horizontal bone augmentation around dental implants with similar promising results compared to Bio-Oss. Finally, the use of Bond apatite preparation is a straightforward, affordable, and considered successful bone graft material that could be used in osseous defect reconstruction procedure. Trial registration:The study is listed on www.clinicaltrials.gov with registration number (NCT06043258) 22/09/2023. The study was conducted in accordance with the seventh revision of the Helsinki Declaration in 2013 and approved by the Institutional Review Board (IRB) (M07061119) of the Faculty of Dentistry, Mansoura University, Egypt.

Bioengineering autologous cartilage grafts for functional posterior lamellar eyelid reconstruction: A preliminary study in rabbits

The reconstruction of posterior lamellar eyelid defects remains a significant challenge in clinical practice due to anatomical complexity, specialized function, and aesthetic concerns. The ideal substitute for the posterior lamellar should replicate the native tarsoconjunctival tissue, providing both mechanical support for the eyelids and a smooth surface for the globe after implantation. In this study, we present an innovative approach utilizing tissue-engineered cartilage (TEC) grafts generated from rabbit auricular chondrocytes and a commercialized type I collagen sponge to reconstruct critical-sized posterior lamellar defects in rabbits. The TEC grafts demonstrated remarkable mechanical strength and maintained a stable cartilaginous phenotype both in vitro and at 6 months post-implantation in immunodeficient mice. When employed as autografts to reconstruct tarsal plate defects in rabbits’ upper eyelids, these TEC grafts successfully restored normal eyelid morphology, facilitated smooth eyelid movement, and preserved the histological structure of the conjunctival epithelium. When applied in bilayered tarsoconjunctival defect reconstruction, these TEC grafts not only maintained the normal contour of the upper eyelid but also supported conjunctival epithelial cell migration and growth from the defect margin towards the centre. These findings highlight that auricular chondrocyte-based TEC grafts hold great promise as potential candidates for clinical posterior lamellar reconstruction. Statement of significanceThe complex structure and function of the posterior lamellar eyelid continue to be significant challenges for clinical reconstructive surgeries. In this study, we utilized autologous auricular chondrocyte-based TEC grafts for posterior lamellar eyelid reconstruction in a preclinical rabbit model. The TEC grafts exhibited native cartilaginous histomorphology and comparable mechanical strength to those of the native human tarsal plate. In rabbit models with either tarsal plate defects alone or bilayered tarsoconjunctival defects, TEC grafts successfully restored the normal eyelid contour and movement, as well as supported preservation and growth of conjunctival epithelium. This is the first study to demonstrate autologous TEC grafts can be employed for repairing tarsal plate defects, thereby offering an alternative therapeutic approach for treating posterior lamellar defects in clinic settings.

RECONSTRUCTION OF A PHARYNGEAL DEFECT IN THE SURGICAL TREATMENT
 OF LOCALLY ADVANCED LARYNGOPHARYNGEAL CANCER:
 LITERATURE REVIEW

Relevance: In 2022, 370 new cases of newly diagnosed patients with laryngeal cancer and 151 with laryngopharyngeal cancer were
 registered in the Republic of Kazakhstan, of which 12.1% of laryngeal cancer at stage IV of the disease and 18.9% of laryngeal cancer. The
 one–year mortality rate for laryngopharyngeal lesions was 40.5%, the ratio between one-year mortality and neglect (stage IV) was 2.3%.For T3-4 laryngopharyngeal cancer, today the only operation of choice is circular resection of the laryngopharynx with laryngectomy and
 the formation of stomas on the neck. The prospect of disability of patients – the formation of pharyngostomy, esophagostomy, tracheostomy,
 constant salivation, the need for probe nutrition, etc., causes irreparable psychological damage to the patient’s personality. In this regard,
 the problem of pharyngeal and laryngopharyngeal reconstruction in cancer patients becomes extremely important not only as a stage of
 rehabilitation, but also as a necessary element in terms of antitumor treatment of this complex category of patients.
 The aim of the study assessment of the significance of pharyngeal defect reconstruction in the surgical treatment of laryngopharyngeal
 cancer in order to improve the rehabilitation of cancer patients and optimize antitumor treatment.
 Methods: Scientific publications were searched in the following databases: PubMed, Medline, eLibrary, Cochrane Lab, using the scientific
 search engine Google Scholar. Criteria for inclusion of publications in the literary review: publications in Russian and English; publications
 included in the PubMed, Medline, e-Library databases; publications with clearly formulated conclusions; publications over the past 10 years.
 Criteria for excluding publications in the literary review: summaries, reports; articles with paid access; abstracts. A total of 82 sources were
 found, and 8 sources were included in the analysis.
 Results: The analysis of the world literature made it possible to widely consider the possibility of performing reconstructive plastic surgery
 using visceral autografts at the stage of surgical treatment of patients with pharyngeal edema. At the same time, the literature describes
 significant reductions in the duration of rehabilitation and improvement of the quality of life of patients, as well as a decrease in the level of
 disability of operated patients.
 Conclusion: Primary plasty of defects that occur after surgical treatment of laryngopharyngeal cancer, using local tissues, displaced and
 free flaps, is undoubtedly the most appropriate way to speed up the rehabilitation of patients and improve the quality of life in the shortest
 possible time.

Propeller Flap: A Feasible Flap for Distal Third of Leg Defects – Two Cases Done at the Plastic Surgery Unit of the Greater Accra Regional Hospital

Introduction: The traditional way of reconstructing soft tissue defects of the lower limb utilized muscle flaps as the ‘gold standard’ for Gustillo Anderson Grade III B fractures of the upper and middle thirds of the leg. Defects of the lower third of the leg are usually reconstructed with free flaps because of paucity and decreased reach of muscles. In resource constrained environments where free flaps are not routine with high failure rates, fasciocuataneous flaps are the only option left. We present our experience with the novel pedicled propeller perforator flaps for reconstruction of soft tissue defects in the lower limb. Case Presentation: Between June and October 2020, 2 consecutive patients - a 34-year-old male and a 51-year-old female, were referred for cover for their distal leg defects from the Orthopedics and trauma Unit. All patients were operated on under spinal anaesthesia. Perforators from posterior tibial and peroneal arteries respectively, were identified pre-operatively with hand-held doppler and the propeller-pattern skin paddle was designed around the perforator closest to defect. After elevation of flaps and skeletonization of perforators, they were then rotated (180 degrees) and inset into defects. Case 1 had whole flap (104 cm2) surviving with only minor marginal epidemiolysis at tip whilst the second flap (58.5cm2) had necrosis of only the business end of the flap but subsequently healed by secondary intention after serial dressings. Both had secondary defects proximally after the rotation, which were skin grafted with 100% take. Conclusion: Propeller flap in our experience, is a feasible versatile option for reconstruction of soft tissue defects in the distal third of the leg.

Paediatric endoscopic endonasal middle skull base reconstruction: retrospective analysis of 78 patients treated in a single tertiary care paediatric center

Introduction Skull base pathologies in the paediatric population are rare and require treatment by multiple qualified specialists. The endoscopic endonasal approach has revolutionized surgical treatment because it is less invasive than existing treatments.The goal of this study was to retrospectively review our experience with the reconstruction of paediatric skull middle base defects and associated complications. Materials and methods We analysed medical records from patients aged ≤ 18 years who were treated at our centre between 2013 and 2021. Patients treated with an endoscopic skull base approach and reconstruction, and who had complete clinical and radiological documentation and a minimum follow-up of 12 months, were included in the analysis. Personal data, reconstructive techniques, and complications were analysed. Results A total of 78 patients met the inclusion criteria and were enrolled in the study. Of these patients, 32 were male and 46 were female, and the mean age was 11.5 years. The main signs and symptoms were as follows: bitemporal hemianopsia in 53 cases, visual impairment in 23 cases, and headache in 30 cases. The most frequent aetiologies were craniopharyngioma (38 cases), pituitary adenoma (23 cases), and clivus chordoma (4 cases). All patients were treated via a pure endoscopic approach. For reconstruction, a multilayer technique was used in 18 cases, naso-septal flap in 43 cases, Gasket-Seal technique in 12 cases, and heterologous reconstruction in 5 cases. Only six patients presented a major complication: two had a postoperative cerebral spinal fluid leak, one developed a brain abscess, and three had diabetes insipidus.The mean follow-up period was 23.4 months.There were no statistically significant differences in postoperative CSF leak in relation to different reconstructive techniques. Conclusion Endoscopic endonasal skull base surgery is a safe and effective treatment for paediatric middle skull base pathologies. Reconstruction techniques have a high success rate of 96.5–100%, and the rate of associated complications is < 3%.

Clinical case of treatment of septic defect of bone and soft tissues of the lower leg

the clinical case is an example of complex reconstruction of septic defect of the tibia tissues, the main principles of which were the reduction of traumatic interventions, the choice of optimal multistage tactics; adequate medication. The soft tissue defect was closed with a rotational sural flap, and the bone defect was replaced with a distraction regenerate with the subsequent use of a semi-rigid system of fixation Softcast-Skotchkast; the data of the EFI and Karlstrom-Olerud external fixation index scales with regard to the complexity of the case according to NUSS objectively confirm this.

Surgical Reconstruction of a Large Defect after Excision of Infiltrative Squamous Cell Carcinoma in the Scalp and Occipital Region: A Case Report

Squamous cell carcinoma (SCC) of the scalp is the second most prevalent skin cancer, following basal cell carcinoma. Notably, it has the capability to infiltrate the skull, dura mater, and even brain tissue. The cornerstone of treatment is the surgical removal of the lesion, with a particular focus on the depth of invasion, which is directly correlated with recurrence rates. Post-surgical strategies may involve immediate or delayed cranial bone reconstruction and repair of scalp defects using either artificial dermis or skin grafts. In the case presented, a substantial defect necessitated more than a single flap for primary repair. Hence, a single pedicle double-island flap was designed for reconstructing the occipital area. Due to increased tension on the flap following cranial bone repair, the bone repair was temporarily deferred. Postoperative care included adjuvant chemotherapy and radiotherapy to mitigate the risk of SCC recurrence.

Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections.

Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.

Injectable microspheres adhering to the cartilage matrix promote rapid reconstruction of partial-thickness cartilage defects

An effective treatment for the irregular partial-thickness cartilage defect in the early stages of osteoarthritis (OA) is lacking. Cartilage tissue engineering is effective for treating full-thickness cartilage defects with limited area. In this study, we designed an injectable multifunctional poly(lactic-co-glycolic acid) (PLGA) microsphere to repair partial-thickness cartilage defects. The microsphere was grafted with an E7 peptide after loading the microsphere with kartogenin (KGN) and modifying the outer layer through dopamine self-polymerization. The microsphere could adhere to the cartilage defect, recruit synovial mesenchymal stem cells (SMSCs) in situ, and stimulate their differentiation into chondrocytes after injection into the articular cavity. Through in vivo and in vitro experiments, we demonstrated the ability of multifunctional microspheres to adhere to cartilage matrix, recruit SMSCs, and promote their differentiation into cartilage. Following treatment, the cartilage surface of the model group with partial-thickness cartilage defect showed smooth recovery, and the glycosaminoglycan content remained normal; the untreated control group showed significant progression of OA. The microsphere, a framework for cartilage tissue engineering, promoted the expression of SMSCs involved in cartilage repair while adapting to cell migration and growth. Thus, for treating partial-thickness cartilage defects in OA, this innovative carrier system based on stem cell therapy can potentially improve therapeutic outcomes. Statement of significanceMesenchymal stem cells (MSCs) therapy is effective in the repair of cartilage injury. However, because of the particularity of partial-thickness cartilage injury, it is difficult to recruit enough seed cells in situ, and there is a lack of suitable scaffolds for cell migration and growth. Here, we developed polydopamine surface-modified PLGA microspheres (PMS) containing KGN and E7 peptides. The adhesion ability of the microspheres is facilitated by the polydopamine layer wrapped in them; thus, the microspheres can adhere to the injured cartilage and recruit MSCs, thereby promoting their differentiation into chondrocytes and accomplishing cartilage repair. The multifunctional microspheres can be used as a safe and potential method to treat partial-thickness cartilage defects in OA.

Impact of skeletal muscle mass on postoperative complications in oral cancer surgery

BackgroundSarcopenia is characterized by a progressive and generalized loss of skeletal muscle mass and strength. The aim of this retrospective study was to investigate the impact of skeletal muscle mass on adverse events in free-flap reconstruction for defects after oral cancer resection.ResultsOf 120 patients, recipient-site adverse events occurred in 56 patients (46.7%), and recipient-site surgical site infections occurred in 45 patients (37.5%). Skeletal muscle index was significantly associated with recipient-site adverse events in univariate analysis (P < 0.05). Lower body mass index and skeletal muscle index were significantly associated with recipient-site surgical site infection in univariate analysis (P < 0.05). In the multiple logistic regression model, a lower skeletal muscle index was a significant risk factor for recipient-site adverse events and surgical site infections (adverse events odds ratio; 3.17/P = 0.04; surgical site infection odds ratio; 3.76/P = 0.02).ConclusionsThe SMI at level Th12 was an independent factor for postoperative AEs, especially SSI, in OSCC patients with free-flap reconstruction.

Free hemi-hamate arthroplasty: A review of donor site outcomes

IntroductionThe use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site. MethodsA retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed. Four hamate defect reconstruction techniques were utilized: no formal reconstruction, autologous bone grafting, gel foam, or synthetic bone substitute. The dorsal capsule was repaired with either extensor retinaculum grafting or by direct closure. Wrist range of motion, pain scores, and radiographic alignment were assessed. ResultsAt 6 months follow-up, all patients achieved full, pain-free wrist motion compared to the uninjured side, with visual analog scale pain scores of 0. Serial radiographs showed maintained carpal alignment without instability or subluxation. No differences based on the hamate defect reconstruction method or capsular repair technique was demonstrated. ConclusionSafe return to pain free, unrestricted wrist function is achievable after HHA, regardless of hamate donor site management. Adequate dorsal capsular repair appears critical to prevent instability. Further study is needed to compare techniques, but choice may be guided by surgeon preference in the absence of clear evidence.

Cranioplasty is not required in the reconstruction of small combined scalp and calvarial defects

BackgroundTreatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty. MethodsRetrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months. ResultsThirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures. ConclusionCombined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.

Reconstruction of a Full-Thickness Nasal Defect.

Reconstruction of a Full-Thickness Nasal Defect.

Conductive and Enhanced Mechanical Strength of Mo2Ti2C3 MXene-Based Hydrogel Promotes Neurogenesis and Bone Regeneration in Bone Defect Repair.

Bone defects are common with increasing high-energy fractures, tumor bone invasion, and implantation revision surgery. Bone is an electroactive tissue that has electromechanical interaction with collogen, osteoblasts, and osteoclasts. Hydrogel provides morphological plasticity and extracellular matrix (ECM) 3D structures for cell survival, and is widely used as a bone engineering material. However, the hydrogels have poor mechanical intensity and lack of cell adhesion, slow gelation time, and limited conductivity. MXenes are novel nanomaterials with hydrophilic groups that sense cell electrophysiology and improve hydrogel electric conductivity. Herein, gelatin had multiple active groups (NH2, OH, and COOH) and an accelerated gelation time. Acrylamide has Schiff base bonds to cross-link with gelatin and absorb metal ions. Deacetylated chitosan improved cell adhesion and active groups to connect MXene and acrylamide. We constructed Mo2Ti2C3 MXene hydrogel with improved elastic modulus and viscosity, chemical cross-linking structure, electric conductivity, and good compatibility. Mo2Ti2C3 MXene hydrogel exhibits outstanding osteogenesis in vitro. Mo2Ti2C3 MXene hydrogel promotes osteogenesis via alkaline phosphatase (ALP) and alizarin red S (ARS) staining, improving osteogenic marker genes and protein expressions in vitro. Mo2Ti2C3 MXene hydrogel aids new bone formation in the in vivo calvarial bone defect model via micro-CT and histology. Mo2Ti2C3 MXene hydrogel facilitates neurogenesis factors nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) expression, and aids newly born neuron marker Tuj-1 and sensory neuron marker serotonin (5-HT) and osteogenesis pathway proteins, runt-related transcription factor 2 (Runx2), osteocalcin (OCN), SMAD family member 4 (SMAD4), and bone morphogenetic protein-2 (BMP2) in the bone defect repair process. Mo2Ti2C3 MXene hydrogel promotes osteogenesis and neurogenesis, which extends its biomedical application in bone defect reconstruction.

Entrapment of the Subscapular Artery between the Radial Nerve and the Posterior Wall of the Axilla: An Anatomical Variation with Clinical Significance

Objective. The subscapular artery vascularizes a substantial region of the thoracic wall, and the significance of its distribution is well depicted in the diversity of reconstructive procedures that rely on its blood supply. The aim of this study is to present an uncommon anatomical variation of the artery and discuss the clinical implications of its presence.&#x0D; Case Report. This case report depicts a rare variant of compression and the kinking of the subscapular artery by the radial nerve on the posterior wall of the axilla that was encountered during dissection of a male cadaver of Greek origin.&#x0D; Conclusion. The use of autologous tissues in the reconstruction of defects and treatment of lymphedema is expanding, so the need to establish safer surgical dissections is also becoming more apparent. The case of entrapment of the subscapular artery by the radial nerve is extremely rare, however, utiliz- ing tissues perfused by this artery for reconstructive purposes could potentially be futile and unsuccessful due to the inadequate blood supply or vessel thrombosis. Hence, the surgeon should adapt the treatment plan according to preoperative findings, as the presence of anatomical variants should always be suspected.

Multipatterned Chondrocytes' Scaffolds by FL-MOPL with a BSA-GMA Hydrogel to Regulate Chondrocytes' Morphology.

Repairing articular cartilage damage is challenging due to its low regenerative capacity. In vitro, cartilage regeneration is a potential strategy for the functional reconstruction of cartilage defects. A hydrogel is an advanced material for mimicking the extracellular matrix (ECM) due to its hydrophilicity and biocompatibility, which is known as an ideal scaffold for cartilage regeneration. However, chondrocyte culture in vitro tends to dedifferentiate, leading to fibrosis and reduced mechanical properties of the newly formed cartilage tissue. Therefore, it is necessary to understand the mechanism of modulating the chondrocytes' morphology. In this study, we synthesize photo-cross-linkable bovine serum albumin-glycidyl methacrylate (BSA-GMA) with 65% methacrylation. The scaffolds are found to be suitable for chondrocyte growth, which are fabricated by homemade femtosecond laser maskless optical projection lithography (FL-MOPL). The large-area chondrocyte scaffolds have holes with interior angles of triangle (T), quadrilateral (Q), pentagon (P), hexagonal (H), and round (R). The FL-MOPL polymerization mechanism, swelling, degradation, and biocompatibility of the BSA-GMA hydrogel have been investigated. Furthermore, cytoskeleton and nucleus staining reveals that the R-scaffold with larger interior angle is more effective in maintaining chondrocyte morphology and preventing dedifferentiation. The scaffold's ability to maintain the chondrocytes' morphology improves as its shape matches that of the chondrocytes. These results suggest that the BSA-GMA scaffold is a suitable candidate for preventing chondrocyte differentiation and supporting cartilage tissue repair and regeneration. The proposed method for chondrocyte in vitro culture by developing biocompatible materials and flexible fabrication techniques would broaden the potential application of chondrocyte transplants as a viable treatment for cartilage-related diseases.

Aesthetic Reconstruction Based on Facial Subunit Principle for Basal Cell Carcinoma of the Face: A Retrospective Analysis.

Background and objective Basal cell carcinoma (BCC) is the most common malignancy of the skin. Reconstruction of post-excisional defects in BCC should follow the subunit principle for better outcomes. The location of BCC of the faceis determined based on facial units; however, very few studies have described the involvement of multiple units and multiple subunits in BCC. In this study, we aimed to provide valuable insights into the management of BCC involving various facial units and subunits, thereby contributing to improved patient care and outcomes. Materials and methods We conducted a retrospective studyat the Plastic Surgery Department of the SCB Medical College in Cuttack, Odisha, from January 2020 to January 2022, after obtaining ethical approvalfrom the SCB Medical College IRB (no: 1155). We examined 35 patients with BCC of the face. The inclusion criteria were as follows: patients with early-stage and primary tumors that were mobile, not attached to underlying bone or cartilage, and amenable to surgical resection. Conversely, patients with late-stage, neglected, and recurrent tumors, fixed tumors, or those infiltrating the underlying bone or cartilage were excluded from the study. Data collection involved retrieving pertinent information from medical records, including parameters such as age, sex, tumor site, type of flap utilized, follow-up, and any complications observed. The tumor sites were further divided into six separate groups based on facial aesthetic units: the forehead, the nose, the area around the eyes, the cheek, the mouth, and the area around the ear, each with its own subunits. Results A total of 35 patients were included in this study, comprising 15 males (42.85%) and 20 females (57.15%), with a male-to-female ratio of 1:1.33. The ages of the patients ranged from 42 to 68 years. Among the facial units, the nose was the most commonly involved (in seven cases), while the lip was the least commonly affected (in one case). In 24 cases, a single unit was involved, while 11 cases involved multiple units. Furthermore, single subunits were affected in 18 cases, double subunits in 10 cases, three subunits in five cases, four subunits in one case, and five subunits in another case. Notably, no cases exhibited flap necrosis, wound dehiscence, wound hematoma, or seroma, indicating excellent surgical outcomes. All flaps remained viable, and all patients were followed up for a minimum of one year, with no reported recurrence during the follow-up period ranging from 6 to 18 months, reaffirming the effectiveness of the treatment approach. Conclusions For small, superficial lesions, full-thickness skin grafts (FTSG) are a suitable treatment option. However, when dealing with larger lesions that encompass multiple subunits, the preferred approach involves reconstructing with locoregional flaps. It is essential to plan the procedure carefully, taking into account the goal of positioning the final scar along the junction of facial subunits. This strategic plan aims to achieve superior aesthetic outcomes.

Reconstruction of a combined defect of the lateral surface of the torso after an explosive injury

Reconstruction of a combined defect of the lateral surface of the torso after an explosive injury

Latissimus dorsi mini flap versus thoracodorsal artery perforator flap in reconstruction of partial mastectomy defects in early breast cancer: a prospective comparative study

Background Breast cancer is the most common cancer type among women and can lead to death. The surgical management of breast cancer has witnessed a considerable evolution in the past few decades. The aim was to compare the thoracodorsal artery perforator (TDAP) flap with the latissimus dorsi (LD) mini flap in the reconstruction of outer quadrants partial mastectomy defects in early breast cancer patients regarding feasibility, cosmesis, postoperative complications, and early musculoskeletal functional outcome. Patients and methods A prospective randomized study was carried out on 40 consecutive female patients complaining of early breast cancer (stages I, II), undergoing partial breast resection (lumpectomy or quadrantectomy with axillary lymph node dissection), and with a small tumor to breast volume ratio. All patients were randomized into two equal groups in a parallel manner by computer-generated numbers, and their allocation code was kept in a closed opaque envelope: group I: early breast cancer (stages I, II) who underwent mastectomy defect by either TDAP flap. Group II: early breast cancer (stage I, II) who underwent mastectomy the LD mini flap. Results Operation time, drain removal, and hospital stay were significantly lower in LD mini-flap group than TDAP flap group (P=0.032, P&lt;0.05, respectively). Complications and reoperation were insignificantly different between the two groups. Shoulder mobility 6 months and breast scar satisfaction was significantly higher in LD mini-flap group than TDAP flap group (P=0.045 and 0.009, respectively). Breast scar satisfaction and total score of satisfaction were significantly higher in LD mini-flap group than TDAP flap group (P&lt;0.05). Time of adjuvant therapy (first cycle) was insignificantly different between both groups. Conclusions In early breast cancer patients, the LD mini flap is a superior technique to TDAP as it had lower operation time, short hospital stays, drain removal, breast scar satisfaction, and total score of patient satisfaction but with high shoulder mobility affection.