Template For Reconstruction Research Articles

Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template.

The present study evaluates the influence of virtual surgical planning with a preoperative 3D resin model on aesthetic and functional outcomes in patients treated by segmental mandibulectomy and reconstruction with fibula-free flap for oral cancer. All consecutive patients who underwent segmental mandibulectomy and mandibular reconstruction with a fibula-free flap using a 3D template at our department from January 2021 to January 2023 were included in the study. "Patients control" were patients treated by reconstruction with a fibula-free flap without using a 3D template. Three-dimensional modeling was performed by converting from preoperative computed tomography to a stereolithography format to obtain the resin 3D models. Qualitative analysis of anatomical and aesthetic results consisted of the evaluation of the patients' aesthetic and functional satisfaction and the symmetry of the mandibular contour observed at clinical examination. Quantitative analysis was based on the assessment of the accuracy and precision of the reconstruction by comparing preoperative and postoperative computed tomograms as objective indicators. Seven patients (five males and two females, mean age of 65.1 years) were included in the study. All patients showed a symmetric mandibular contour based on the clinical examination. After recovery, six patients (85.7%) considered themselves aesthetically satisfied. The quantitative analysis (assessed in six/seven patients) showed that the mean difference between preoperative and postoperative intercondylar distance, intergonial angle distance, anteroposterior dimension, and gonial angle improved in the 3D template-assisted group. The 3D-printed template for mandibular reconstruction with microvascular fibula-free flap can improve aesthetic outcomes in comparison with standard approaches.

Use of Biodegradeable Temporizing Matrix Dermal Template for Reconstruction of Upper Extremity Soft Tissue Defects with Associated Tendon Injury.

In cases of complex upper extremity soft tissue defects with exposed bone or tendon, the surgeon needs to consider both restoration of stable soft tissue coverage and functional outcomes, which requires early motion and a wound bed suitable for tendon gliding. Often, local, regional, or free flaps are necessary; however, good outcomes have also been reported after staged reconstruction with a dermal template and split-thickness skin grafting. To our knowledge, staged reconstruction with a dermal template has not been described for soft tissue defects with an associated underlying tendon injury requiring tenorrhaphy. We have previously reported our experience with a synthetic dermal template [Novosorb BTM (Biodegradable Temporizing Matrix), Polynovo North America LLC. Carlsbad, Calif.] for the reconstruction of complex upper extremity defects with exposed tendon and showed that it consistently and reliably integrates even when these patients were treated with an early, active therapy protocol. As a result of these findings, we hypothesized that BTM could potentially be used over a tendon repair site without compromising functional outcomes. Here, we report on clinical outcomes for two patients with upper extremity injury where BTM was applied directly over a tendon repair or transfer site and resulted in stable soft tissue coverage with excellent tendon gliding. These early results show that this approach might be considered as an alternative to autologous tissue reconstruction in these patients and could reduce donor site morbidity associated with flap harvest.

3D-print as a template for reassembly of skull fragments in a homicide case

In this technical note we report a case where 3D-printing aided the reassembly of skull fragments in a homicide with severe tampering of the bones. A young male was shot, the body was incinerated and crushed with garden tools resulting in hundreds of brittle, calcine bone fragments from the skull. An antemortem computed tomography (CT)-scan of the skull was available from a previous assault of the victim. To aid the process of reassembly we used the antemortem CT-data to develop a 3D fixture-grid of the cranial cavity. The 3D grid was utilized as an anatomically correct template for bone reconstruction. This novel technique was based solely on open-source software including 3D Slicer and Blender and could have the potential to aid similar cases.

Prediction of the Proximal Humerus Morphology Based on a Statistical Shape Model with Two Parameters: Comparison to Contralateral Registration Method.

(1) Background: Complex proximal humerus fractures often result in complications following surgical treatment. A better understanding of the full 3D displacement would provide insight into the fracture morphology. Repositioning of fracture elements is often conducted by using the contralateral side as a reconstruction template. However, this requires healthy contralateral anatomy. The purpose of this study was to create a Statistical Shape Model (SSM) and compare its effectiveness to the contralateral registration method for the prediction of the humeral proximal segment; (2) Methods: An SSM was created from 137 healthy humeri. A prediction for the proximal segment of the left humeri from eight healthy patients was made by combining the SSM with parameters. The predicted proximal segment was compared to the left proximal segment of the patients. Their left humerus was also compared to the contralateral (right) humerus; (3) Results: Eight modes explained 95% of the variation. Most deviations of the SSM prediction and the contralateral registration method were below the clinically relevant 2 mm distance threshold.; (4) Conclusions: An SSM combined with parameters is a suitable method to predict the proximal humeral segment when the contralateral CT scan is unavailable or the contralateral humerus is unhealthy, provided that the fracture pattern allows measurements of these parameters.

Anatomical variation in humeri: gender and side comparison using statistical shape modelling.

The surgical management of proximal humeral fractures remains challenging. Anatomical reduction of the fracture has been reported as the keystone for a sufficient surgical fixation and successful outcome. However, mostly there is no example of its premorbid state. Literature suggests that the mirrored contralateral side can be used as a reconstruction template. But is this a correct technique to use? The purpose of this study is to define anatomical variation between humeri based on gender and side comparison. Two different statistical shape models of the humerus were created and their modes of variation were described. One model contained 110 unpaired humeri. The other model consisted of 65 left and corresponding right humeri. The compactness of the statistical shape model containing 110 humeri showed that two principal components explain more than 95% of the variation and the generalization showed that a random humerus can be described with an accuracy of 0.39mm. For only three parameters, statistically significant differences were observed between left and right. However, comparing the mean of the different metrics on the humeri of men and women, almost all were significant. Since there were only small differences between left and right humeri, using the mirrored contralateral side as a reconstruction template for fracture reduction can be defended. The variable anatomy between men and women could explain why locking plates not always fit to the bone.

The LipoDerm Method for Regeneration and Reconstruction in Plastic Surgery: A Technical Experimental Ex Vivo Note

The combination of adipose-derived stem cells (ASCs) and dermal scaffolds has been shown to be an approach with high potential in soft tissue reconstruction. The addition of dermal templates to skin grafts can increase graft survival through angiogenesis, improve regeneration and healing time, and enhance the overall appearance. However, it remains unknown whether the addition of nanofat-containing ASCs to this construct could effectively facilitate the creation of a multi-layer biological regenerative graft, which could possibly be used for soft tissue reconstruction in the future in a single operation. Initially, microfat was harvested using Coleman's technique, then isolated through the strict protocol using Tonnard's technique. Finally, centrifugation, emulsification, and filtration were conducted to seed the filtered nanofat-containing ASCs onto Matriderm for sterile ex vivo cellular enrichment. After seeding, a resazurin-based reagent was added, and the construct was visualized using two-photon microscopy. Within 1 h of incubation, viable ASCs were detected and attached to the top layer of the scaffold. This experimental ex vivo note opens more dimensions and horizons towards the combination of ASCs and collagen-elastin matrices (i.e., dermal scaffolds) as an effective approach in soft tissue regeneration. The proposed multi-layered structure containing nanofat and dermal template (Lipoderm) may be used, in the future, as a biological regenerative graft for wound defect reconstruction and regeneration in a single operation and can also be combined with skin grafts. Such protocols may optimize the skin graft results by creating a multi-layer soft tissue reconstruction template, leading to more optimal regeneration and aesthetic outcomes.

Registration based assessment of femoral torsion for rotational osteotomies based on the contralateral anatomy

BackgroundComputer-assisted techniques for surgical treatment of femoral deformities have become increasingly important. In state-of-the-art 3D deformity assessments, the contralateral side is used as template for correction as it commonly represents normal anatomy. Contributing to this, an iterative closest point (ICP) algorithm is used for registration. However, the anatomical sections of the femur with idiosyncratic features, which allow for a consistent deformity assessment with ICP algorithms being unknown. Furthermore, if there is a side-to-side difference, this is not considered in error quantification.The aim of this study was to analyze the influence and value of the different sections of the femur in 3D assessment of femoral deformities based on the contralateral anatomy.Material and methods3D triangular surface models were created from CT of 100 paired femurs (50 cadavers) without pathological anatomy. The femurs were divided into sections of eponymous anatomy of a predefined percentage of the whole femoral length. A surface registration algorithm was applied to superimpose the ipsilateral on the contralateral side. We evaluated 3D femoral contralateral registration (FCR) errors, defined as difference in 3D rotation of the respective femoral section before and after registration to the contralateral side. To compare this method, we quantified the landmark-based femoral torsion (LB FT). This was defined as the intra-individual difference in overall femoral torsion using with a landmark-based method.ResultsContralateral rotational deviation ranged from 0° to 9.3° of the assessed femoral sections, depending on the section. Among the sections, the FCR error using the proximal diaphyseal area for registration was larger than any other sectional error. A combination of the lesser trochanter and the proximal diaphyseal area showed the smallest error. The LB FT error was significantly larger than any sectional error (p < 0.001).ConclusionWe demonstrated that if the contralateral femur is used as reconstruction template, the built-in errors with the registration-based approach are smaller than the intraindividual difference of the femoral torsion between both sides. The errors are depending on the section and their idiosyncratic features used for registration. For rotational osteotomies a combination of the lesser trochanter and the proximal diaphyseal area sections seems to allow for a reconstruction with a minimal error.

Nanomaterials for the delivery of bioactive factors to enhance angiogenesis of dermal substitutes during wound healing.

Dermal substitutes provide a template for dermal regeneration and reconstruction. They constitutes an ideal clinical treatment for deep skin defects. However, rapid vascularization remains as a major hurdle to the development and application of dermal substitutes. Several bioactive factors play an important regulatory role in the process of angiogenesis and an understanding of the mechanism of achieving their effective delivery and sustained function is vital. Nanomaterials have great potential for tissue engineering. Effective delivery of bioactive factors (including growth factors, peptides and nucleic acids) by nanomaterials is of increasing research interest. This paper discusses the process of dermal substitute angiogenesis and the roles of related bioactive factors in this process. The application of nanomaterials for the delivery of bioactive factors to enhance angiogenesis and accelerate wound healing is also reviewed. We focus on new systems and approaches for delivering bioactive factors for enhancing angiogenesis in dermal substitutes.

A method of fast locating discrete interface based on phase information of complex master-slave optical coherence tomography

Spectral-domain optical coherence tomography (SD-OCT) system has the advantages of non-invasive, non-contact, fast imaging and low cost. It has important applications in the measurement of discrete interface of optical lens. However, the interference spectrum collected by spectral domain OCT system inevitably encounters some problems such as the unequal interval spectrum sampling and chromatic dispersion between two interference arms. In order to ensure that the axial resolution and sensitivity of the system are not reduced, subsequent data processing steps such as spectrum resampling and dispersion compensation need adding, which greatly reduces the real-time performance of measurement. In addition, in the actual measurement process, the required imaging area is often only a small part of the whole imaging area, the calculation of the whole imaging area brings a certain waste of computing power and resources. Moreover, in the positioning of discrete interface, the existence of sub-pixel deviation under limited axial resolution limits the measurement accuracy of interface. To solve the above problems, in this work proposed is a method of fast locating discrete interfaces based on complex master slave (CMS) OCT phase information. By combining the phase information of spectral domain and depth domain, the reconstruction template of CMS-OCT is solved accurately, and the phase information of CMS-OCT is used to achieve high-precision optical path difference detection and discrete interface location. Finally, experiments with precise optical gauge and discrete interface of optical lens verify that the proposed method can maintain high resolution and stability while fast locating is implemented.

Mixed Reality Intraoperative Navigation in Craniomaxillofacial Surgery.

We report our early experience with the HoloLens 2 (Microsoft Corp., Redmond, Wash.) mixed reality device1 in the management of patients with craniomaxillofacial trauma. Preoperative planning is performed using iPlan Cranial Version 2.6 (Brainlab, Munich, Germany). The contralateral uninjured facial skeleton is mirrored for use as a template for reconstruction. This skull reference model is exported as a Standard Tessellation Language file. This is uploaded onto the HoloLens 2 system by means of the software Virtual Surgery Intelligence (apoQlar GmbH, Hamburg, Germany), which generates a skull reference hologram. Intraoperatively, superimposition of the skull reference hologram onto the patient is performed after fracture exposure (Fig. 1). Predetermined exposed bony landmarks on the patient were matched. These were visually verified on the frontal, lateral, and worm’s-eye views. Having the hologram projected directly on the operative field allows surgeons to have a better appreciation of the vector and magnitude of movement required for fracture reduction. Surgeons can visualize structures beyond the area of exposure. Adequacy of fracture reduction can be validated immediately. Adjustments can be made and validations repeated. Fixation is performed once reduction is satisfactory.Fig. 1.: Alignment of skull reference hologram is performed using multiple exposed bony landmarks to improve accuracy.The main advantage of mixed reality is its ability to allow visualization and manipulation of superimposed holograms on patients in real time. The experience is akin to a live “in-flight” image-guided surgery. There is immediate feedback on the adequacy of reduction. Surgeons are able to directly visualize the skull reference hologram superimposed on the patient’s skull through the lens, without changes in line of sight. Limitations include the arbitrary nature of aligning the skull reference hologram onto the patient. Mitsuno et al.2 described a three-point technique of alignment. A more precise technique is required in craniomaxillofacial surgery. Our described technique is adapted from the registration process with current navigation devices. Greater accuracy can be attained by aligning a larger number of landmarks directly on exposed bones that are to be operated on. Advances that we are developing include the following: Automated stereoscopic registration and alignment of skull reference hologram: This removes the subjectivity and time involved in the process of superimposing the hologram onto the patient. Automated and objective validation of fracture reduction: A system that automatically detects the extent of deviation of the reduced fracture fragments from the skull reference hologram. Adjustments and reduction can be made more accurately. Soft-tissue segmentation and visualization: Critical soft-tissue structures such as nerves can be superimposed alongside the skull reference model, visualized, and preserved intraoperatively. Instrument recognition and early warning system: Instruments can be registered onto the system and be recognized intraoperatively. When positioned in close proximity to critical structures such as the optic nerve, the system detects this and sends out an early warning signal such that inadvertent injury to these structures can be avoided. Mixed reality devices provide surgeons with real-time intraoperative guidance. It has the potential to decrease operative time and improve patient outcomes. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this article.

Forehead Flap Templates for Nasal Reconstruction Digitally Developed From 2D and 3D Images.

The forehead flap is the gold standard procedure for nasal reconstruction to address a partial or complete rhinectomy. Traditionally, the three-dimensional (3D) nasal defect is manually templated intraoperatively to design the two-dimensional (2D) flap shape on intact morphology. In this clinical study, digital preoperative planning is used to template with computer-assisted design and manufacturing. Preoperative digital templates were implemented for 3 representative patients (1 in Supplementary Digital Content, http://links.lww.com/SCS/D60). This includes designs for a hemi-rhinectomy case from 3D mirroring, a partial total rhinectomy case generated from a 3D scan, and a total rhinectomy case generated from a 3D morphable model based on a prepathology 2D photo. Digital unwrapping flattened the patient's 3D nasal geometry designs to 2D skin flap shapes. Finally, the 2D designs were printed as traceable intraoperative templates at a 1:1 scale. This clinical study demonstrates the application of digital 3D preoperative templating to improve workflow for nasal reconstruction.

An Alternative Dermal Template for Reconstruction of Complex Upper Extremity Wounds.

Summary:The management of upper extremity soft-tissue defects with full-thickness skin loss and denuded tendon and/or bone traditionally requires vascularized tissue reconstruction. Herein, we present patient outcomes utilizing Novosorb Bio-degradable Temporizing Matrix (PolyNovo, Wilmington, Del.), a novel bilaminar dermal regenerative template, followed by skin grafting, for reconstruction of complex upper extremity injuries with exposed tendon and/or bone. We retrospectively reviewed all patients treated at our Level I trauma center with upper extremity trauma and exposed tendon and/or bone who had application of Novosorb Bio-degradable Temporizing Matrix over a 1-year period. At the time of surgery, all nonviable tissue was debrided, and the product was applied according to the manufacturer’s instructions. If required, split thickness skin grafting was performed once neodermis appeared perfused, or after the sealing layer delaminated spontaneously. Six patients (four men, two women) with an average age of 49.8 (35–60) years were included in the study. Average defect size measured 97 cm2 (10–440). Average time to complete healing was 45 days (27–57). Three patients reepithelialized spontaneously and did not require grafting; average defect size in these patients was 26 cm2 (10–42). There were no infections and no loss of the dermal matrix or skin graft, when performed. All patients healed without complication after grafting and did not require further surgical treatment. Therefore, we contend that Novosorb BTM is a dermal regenerative template that shows potential as an alternative option to flap reconstruction in select patients after upper extremity trauma and soft-tissue defects with exposed tendon and/or bone. Further studies will be required to refine indications and evaluate outcomes.

Microtia deformity correction with three-dimensional and two-dimensional templates: A pathway for effective ear reconstruction

Expression of anatomical landmarks of the ear results in the success of ear reconstruction in microtia. Ear reconstruction in India is routinely done with a two-dimensional (2D) template by tracing the contralateral ear with an X-ray sheet. There is a need of a proper template to understand the finer details of the ear reconstruction. In this report, a three-dimensional (3D) template in association with a 2D template is utilised to augment the reconstruction ability of the plastic surgeon. After computed tomography scan, an accurate 3D scan of the normal ear is obtained. Using the 3D ear model file, a negative mould of the ear 3D model is developed and fed into a 3D printer. The model is sterilised and used for reconstruction. Hyperbaric oxygen therapy is used as an adjunct for the procedure. Simultaneous utilisation of 3D and 2D templates for ear reconstruction appears to increase the ability of plastic surgeons to recreate the ear.

A Template-Based 3D Reconstruction of Colon Structures and Textures From Stereo Colonoscopic Images

This article presents a framework for 3D reconstruction of colonic surface using stereo colonoscopic images. Due to the limited overlaps between consecutive frames and the nonexistence of large loop closures during a normal screening colonoscopy, the state-of-art simultaneous localization and mapping (SLAM) algorithms cannot be directly applied to this scenario, thus a colon model segmented from CT scans is used together with the colonosocopic images to achieve the colon 3D reconstruction with high accuracy. The proposed framework includes 3D scan (point cloud with RGB information) reconstruction from stereo images, a visual odometry (VO) based camera pose initialization module, a 3D registration scheme for matching texture scans to the segmented colon model, and a barycentric-based texture rendering module for mapping textures from colonoscopic images to the reconstructed colonic surface. A realistic simulator is developed using Unity to simulate the procedures of colonoscopy and used to provide experimental datasets in different scenarios. Experimental results demonstrate the good performance of the proposed 3D colonic surface reconstruction method in terms of accuracy and robustness. Currently, the framework requires a pre-operative colon model as the template for colon reconstruction and can reconstruct 3D colon maps when the colon has no large deformation and the colon structure is clearly visible. The datasets used in this article and the developed simulator are made publicly available for other researchers to use (https://github.com/zsustc/colon_reconstruction_dataset).

Detection Method of Three-Dimensional Echocardiography Based on Deep Learning

In order to improve the detection and recognition ability of 3D echocardiography, a method of 3D echocardiography detection based on depth learning is proposed. The information conduction model of three-dimensional echocardiography is constructed. The edge pixel feature matching method is used to extract the key information of echocardiography, and the information compensation method is used to repair the missing area of three-dimensional echocardiography information. The feature decomposition and information fusion of 3D ultrasonic imaging are carried out by using five stage wavelet decomposition method, and the feature reconstruction and adaptive template matching of 3D echocardiography are processed by depth learning algorithm, modeling and detecting the rationality of three-dimensional echocardiography. The simulation results show that this method has better detection performance; the accuracy of detection and recognition is high, which is more reasonable in the application of 3D echocardiography repair and detection recognition.

Recent advances in the surgical treatment of malunions in hand and forearm using three-dimensional planning and patient-specific instruments

Malunions of the forearm and hand cause significant disability. Moreover, intraarticular deformities may contribute to early onset osteoarthritis. Such conditions require precise surgical correction in order to improve functional outcomes and prevent early or late complications. The purpose of this study was to describe the technical advantages of accurate anatomical reconstruction using 3D guided osteotomies and patient specific instruments (PSI) in multiple joints of the hand and forearm. Acquisition of three-dimensional (3D) datasets and surgical implementation of PSI was performed in a series of patients between December 2014 and July 2017. Patients had intra- or extra-articular malunions of the forearm, radiocarpal joint, trapeziometacarpal joint, or proximal interphalangeal joint. A previously described 3D surface model that incorporates CT data was used for segmentation (Mimics®, Materialise™, Belgium). For all the cases, CT scans of both forearms were acquired to use the contralateral uninjured side as the anatomic reconstruction template. Computer-assisted assessment of the deformity, the preoperative plan, and the design of PSI are described. Outcomes were determined by evaluating step-off correction, fusion, changes in range of motion (ROM) and grip strength. Six patients were included in the study; all achieved fusion. Improved clinical outcomes including pain reduction, better ROM and grip strength were obtained. Complete correction of intraarticular step-off was achieved in all cases with intraarticular malunions. 3D guided osteotomies are an established surgical treatment option for malunions of the hand and forearm. 3D analysis is a helpful diagnostic tool that provides detailed information about the underlying deformity. PSI can be developed and used for surgical correction with maximal accuracy for both intraarticular step-off and angular deformity.

Three-dimensional meniscus allograft sizing\u2014a study of 280 healthy menisci

BackgroundInaccurate meniscus allograft size is still an important problem of the currently used sizing methods. The purpose of this study was to evaluate a new three-dimensional (3D) meniscus-sizing method to increase the accuracy of the selected allografts.Methods3D triangular surface models were generated from 280 menisci based on 50 bilateral and 40 unilateral knee joint magnetic resonance imaging (MRI) scans. These models served as an imaginary meniscus allograft tissue bank. Meniscus sizing and allograft selection was simulated for all 50 bilateral knee joints by (1) the closest mean surface distance (MeSD) (3D-MRI sizing with contralateral meniscus), (2) the smallest meniscal width/length difference in MRI (2D-MRI sizing with contralateral meniscus), and (3) conventional radiography as proposed by Pollard (2D-radiograph (RX) sizing with ipsilateral tibia plateau). 3D shape and meniscal width, length, and height were compared between the original meniscus and the selected meniscus using the three sizing methods.ResultsAllograft selection by MeSD (3D MRI) was superior for all measurement parameters. In particular, the 3D shape was significantly improved (p < 0.001), while the mean differences in meniscal width, length, and height were only slightly better than the allograft selected by the other methods. Outliers were reduced by up to 55% (vs. 2D MRI) and 83% (vs. 2D RX) for the medial meniscus and 39% (vs. 2D MRI) and 56% (vs. 2D RX) for the lateral meniscus.Conclusion3D-MRI sizing by MeSD using the contralateral meniscus as a reconstruction template can significantly improve meniscus allograft selection. Sizing using conventional radiography should probably not be recommended.Trial registrationKantonale Ethikkommission Zürich had given the approval for the study (BASEC-No. 2018-00856).

Development of a template tool for facilitating fibula osteotomy in reconstruction of mandibular defects by digital analysis of the human mandible

ObjectivesMandibular reconstruction after segmental mandibulectomy can be challenging without virtual surgical planning and osteotomy guides. The purpose of this study was to analyze anatomic parameters to facilitate the evaluation of ideal fibula wedge osteotomies to reconstruct the neomandibula in a simple and cost-effective manner without the need for preoperative virtual planning.Materials and methodsComputed tomography scans were acquired from randomly selected patients, and all images were obtained from routine clinical diagnostics, e.g., tumor staging, or preoperatively before reconstruction. Data was used to calculate stereolithographic models of the mandible for length and angle measurements. Statistical analysis was performed (p < 0.05).ResultsCT scans of 100 patients were analyzed: 39 were female and 61 were male patients, mean age was 59.08a. The mandibular arch angle proved to be constant with 241.07 ± 2.39°. The outside B-segment length was 80.05 ± 5.16 mm; the anterior S-segment length was 27.69 ± 3.16 mm. The angle of the mandibular arch showed differences in means (p = 0.004) between age groups, but effect was proved low. No relevant statistical significances were detected.ConclusionsThe development of a mandible reconstruction template tool would benefit the majority of head and neck patients, which is due to a constant mandibular arch angle and symphysis segment length throughout the general patient population, allowing the mimicking of a harmonic mandibular arch with up to three fibula segments.Clinical relevanceThe developed mandible reconstruction template tool can facilitate the fibula wedge osteotomies necessary for reconstruction of an ideal neomandibula providing a novel approach which is simple and cost-effective.

Use of Integra for Reconstruction after Nevi Resection: A Systematic Review and Pooled Analysis of Reported Cases.

Background The use of Integra Dermal Reconstruction Template has emerged as an option for wound reconstruction, after resection of congenital nevi, especially giant congenital nevi. There have been many reports on Integra use in the literature for this purpose. This systematic review with pooled analysis examines the current literature regarding Integra use after resection of congenital nevi, including patient characteristics and reported outcomes. Methods Systematic electronic searches were performed using PubMed, Ovid, Embase, and Cochrane library databases for studies reporting the use of Integra to reconstruct defects after nevi resection. Studies were analyzed if they met the inclusion criteria. Pooled descriptive statistics were performed. Results Thirteen studies that met the inclusion criteria were included for analysis, yielding 31 procedures in 31 patients. Eleven of the thirteen studies were case reports representing 17 of the 31 patients. One study was retrospective, and the other study was a prospective study. The mean follow-up was 2.67 years (range, 0.2–13 years). The overall wound closure rate was 100%. The overall initial Integra take rate was 90.3% and the skin graft take rate was 100%. The rate of reported complications was 14.8%. The average age of patients was 7.36 years. The average size of the nevus was 6.29% TBSA (range, 0.005%–26%), and the time to definitive skin grafting was 3.28 weeks. Significant heterogeneity was found among the published studies. Conclusion We conclude that the use of Integra appears to be a safe and viable option for defect reconstruction after the primary or secondary excision of congenital nevi of different sizes and on most parts of the body. Long-term follow-up studies and prospective cohort studies are required in order to fully estimate the incidence of complications. However, the rarity of this condition make these types of studies very difficult.

Contralateral MRI scan can be used reliably for three-dimensional meniscus sizing — Retrospective analysis of 160 healthy menisci

BackgroundMeniscus allograft transplantation is a valuable surgical option for post-meniscectomy syndrome. For best results, the selected allograft should be as similar as possible to the original meniscus. Three-dimensional meniscus sizing could be a new approach to improve the accuracy of meniscus matching. The contralateral anatomy might therefore be a suitable reconstruction template. The purpose of this study was to compare the three-dimensional shape of the right and left menisci by bi-planar segmentation of magnetic resonance imaging (MRI) scans. MethodsThree-dimensional surface models of healthy menisci were created based on 40 bilateral MRI scans. Manual segmentation was performed on the MRI data in sagittal and coronal planes. For side-to-side comparison, each left meniscus model was mirrored and then superimposed to its corresponding right meniscus model. Differences between the meniscus pairs were assessed by width, length, height and surface distances. Inter-reader reliability, as well as accuracy of bi-planar segmentation was assessed by two different readers. ResultsThe meniscus pairs were not significantly different in terms of width, length and height (P = at least 0.138). Side difference of mean surface distances was 0.76 mm (±0.13 standard deviation (SD)) for medial and 0.78 mm (±0.15 SD) for lateral menisci. Inter-reader reliability was good to excellent (0.828–0.987). ConclusionThe three-dimensional shapes of the left and right menisci are very similar. Therefore, the contralateral meniscus can be used as a template for three-dimensional meniscus allograft sizing. Three-dimensional meniscus segmentation and sizing can be performed accurately by combination of sagittal and coronal planes.