Soft Defects Research Articles

Case report: Posterior arm perforator flap for reconstruction of axillary defect after infected radiation-induced ulcer

Axillary soft tisue defects are uncommon in Vietnam. We report a case of an 81-year-old female patient had an infected axillary skin ulcer after going through a radical surgery and radiation therapy 30 years ago. In this case, a CT scanner was used to evaluate the fundus of the lesion and biopsy to rule out malignancy. The treatment procedure was eliminating infection based on the antibiogram, wound care, debridement, negative pressure wound therapy and reconstruction of defect. The optimal choice in this case was to use posterior arm perforator flap. After the surgery, the flap had a good vitality and the wound healed after 3 weeks. The case affirmed that the posterior arm perforator flap is suitable for axillary coverage and should be considered as one of the main options for axillary reconstruction.

Mature Cystic Oral Teratoma in a Neonate- A Case Report.

Neonatal oral cavity masses present complex diagnostic and management challenges, often involving respiratory distress. We present a case of a 1-day-old male neonate with an oral cavity mass and respiratory distress, whose antenatal scan revealed polyhydramnios and a nasopalatine cyst. Clinical examination revealed a 5 * 5cm cystic swelling arising from the right hard palate. CT scans confirmed an intraoral cystic lesion with a complete cleft palate and excluded oropharyngeal/neck extension. Aspiration of cystic fluid facilitated surgical excision, leading to a histopathological diagnosis of mature cystic teratoma. Primary closure of the soft palate defect was performed. Histopathological examination revealed it to be mature cystic teratoma. This case underscores the intricate interplay between antenatal imaging, clinical assessment, and surgical intervention in managing neonatal oral cavity masses. The successful excision and histopathological confirmation of a mature cystic teratoma highlights the significance of accurate diagnosis and timely intervention. The complexities surrounding neonatal oral cavity masses necessitate a comprehensive approach to optimize patient outcomes.

An integrated hollow bulb obturator prosthesis with a metal framework for a soft palate defect fabricated by multiple digital techniques.

The digital workflow to fabricate an integrated hollow bulb obturator prosthesis with a metal framework for a patient with soft palate defect is described. The framework was digitally designed with an open lattice denture base connector to facilitate the assembly of the hollow bulb obturator and printed with titanium. A functional impression of the palatopharyngeal area was made, and an integrated 3-dimensional (3D) cast was obtained by aligning the data of the functional impression to the preliminary intraoral scan data. The hollow bulb obturator and a palatal cover were designed based on the integrated 3D cast and the framework design data and printed with light-polymerizing denture base resin. The printed framework, obturator, and palatal cover were assembled and bonded without a physical cast, and the definitive prosthesis exhibited good fit, retention, and stability.

Unilateral gingival enlargement in a patient with neurofibromatosis type 1 - Case report

Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is an autosomal disease caused by mutations in the NF1 tumor suppressor gene. NF1 affects bones, nerves, soft tissues and skin. Oral manifestations of NF1 consist of soft tissue tumors, bone defects, periodontal and dental changes, and altered salivary flow. We report one such case, a 26-year-old man with Gingival enlargement, Café au lait spots, axillary freckling, and multiple nodules on his body.

Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer.

Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V-Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick-DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two-point discrimination (2-PD) of the finger pulp was used as a measure of tactile agnosia. All donor site wounds healed well. The average follow-up time was 23.6 months (6-39 months). The mean Quick-DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2-PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger.

Influence of tongue pressure on the obturator prosthesis for soft palate defects: a 3D-FEA study

Influence of tongue pressure on the obturator prosthesis for soft palate defects: a 3D-FEA study

Soft Palate Dysplasia: Properties and Surgical Techniques.

The authors aimed to report a hitherto undescribed class of patients with the obvious phenotype of a novel soft palate dysplasia (SPD) combining unilateral soft palate hypoplasia with a fully developed uvula. The authors also aimed to investigate and evaluate the corresponding surgical approaches. Twelve patients were clinically diagnosed with SPD. Clinical examination, including radiographic tests, was performed to characterize the congenital deformity. The effectiveness of velopharyngeal closure and speech were tested preoperatively and postoperatively. SPD was featured with velopharyngeal insufficiency, food regurgitation, and speech disorders. It was commonly manifested as structural deformities of the soft palate, tongue palatine arch, pharyngeal palatine arch, and pterygomandibular fold, but with complete uvula shape. According to radiographic analysis, in five patients, the lateral pterygoid processes were poorly developed, and other malformations were present. Velopharyngoplasty based on the unilateral posterior pharyngeal flap can well restore the velopharyngeal closure and speech intelligibility without respiration obstruction. SPD is characterized as congenital velopharyngeal insufficiency manifested as a primary soft palate defect. It is highly associated with other physical deformities but independent of conventionally known syndromes. The cause may be an abnormal development of the pterygoid process. Unilateral velopharyngoplasty based on the posterior pharyngeal flap is a great technique to repair SPD. Therapeutic, IV.

Structural Anisotropy Governs the Kink Formation in Cellulose Nanocrystals

Understanding the defect structure is fundamental to correlating the structure and properties of materials. However, little is known about the defects of soft matter at the nanoscale beyond their external morphology. We report here on the molecular-level structural details of kink defects of cellulose nanocrystals (CNCs) based on a combination of experimental and theoretical methods. Low-dose scanning nanobeam electron diffraction analysis allowed for correlation of the local crystallographic information and nanoscale morphology and revealed that the structural anisotropy governed the kink formation of CNCs. We identified two bending modes along different crystallographic directions with distinct disordered structures at kink points. The drying strongly affected the external morphology of the kinks, resulting in underestimating the kink population in the standard dry observation conditions. These detailed defect analyses improve our understanding of the structural heterogeneity of nanocelluloses and contribute to the future exploitation of soft matter defects.

Implant-prosthetic dental rehabilitation after autopolytrauma

With extensive damage of the facial skeleton, multiple bony and soft tissue cicatricial defects and deformations are formed. Traditional methods of reconstructive are reliably not able to restore the defects fully. Often the bony structures of the facial skeleton can’t be restored in one stage. Additional reconstructive surgeries are needed. A problematic situation is the condition after multiple surgeries in the defect area. Failure of bone grafting is associated with cicatricial deformities and lack of soft tissue, lack of gingiva, defects in the vestibule and damaged periosteum. The main problem is constriction and subsequent atrophy and deformation of the soft tissue in the area of the defect. This complicates further treatment and often it isn’t possible to restore the bone volume required for a successful dental implantation. Implant prosthetic rehabilitation in the area of extensive bone defects after a facial injury requires preparation that is more careful, design and prototyping of the outcome with the use of computer programs and diagnostic models. Biocompatible materials for dentistry and maxillofacial surgery are clinically proven and recommended for usage in patients at the treatment stages. Clinical experience with individual temporary endoprosthesis, so called «tissue expander», produced by layer-by-layer synthesis (3D-printing) from biologically inert plastic based on CT data of the patient is presented in this article. The expander is made in the form of a 3D element to form the required soft tissue volume in the patient for 4-6 months and is fixed in place subcutaneously, in the area of mandibular frontal defect, using intraosseous screws. Dental implants were placed laterally on both sides. The following was carried out intraoperative direct replacement, fabrication and placement in the mouth of a temporary screw-retained prosthesis.

Folded Radial Forearm Free Flap for the Reconstruction of Total Soft Palate Defects: Operative Technique.

Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap. All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned. The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate.

Time- and Space-Varying Neutrino Mass Matrix from Soft Topological Defects.

We study the formation and evolution of topological defects that arise in the postrecombination phase transition predicted by the gravitational neutrino mass model in Dvali and Funcke [Phys. Rev. D 93, 113002 (2016)PRVDAQ2470-001010.1103/PhysRevD.93.113002]. In the transition, global skyrmions, monopoles, strings, and domain walls form due to the spontaneous breaking of the neutrino flavor symmetry. These defects are unique in their softness and origin; as they appear at a very low energy scale, they only require standard model particle content, and they differ fundamentally depending on the Majorana or Dirac nature of the neutrinos. One of the observational signatures is the time dependence and space dependence of the neutrino mass matrix, which could be observable in future neutrino experiments. Already existing data rule out parts of the parameter space in the Majorana case. The detection of this effect could shed light onto the open question of the Dirac versus Majorana neutrino nature.

Phase stability and coercivity in La2Fe14B magnet

Critical rare-earth free La2Fe14B (2:14:1) has the potential to be a gap permanent magnet. However, La2Fe14B decomposes into La, α-Fe, and LaFe4B4 phases below 1067 K. The phase stability and coercivity have been studied in La2Fe14B magnet using first principles DFT (density functional theory) calculation and micromagnetic simulation. For a perfect La2Fe14 B cube (edge length of 256 nm) without any structural defects and soft magnetic secondary phases, the coercivity (8.5 kOe) is reduced to ∼40% of its magnetocrystalline anisotropy field (HA = 20 kOe). Further, the coercivity sharply reduces to 3.2 kOe upon forming a thin layer (2 nm) of α-Fe on the surface of the La2Fe14B cube particle. The DFT calculations indicate that a partial replacement of La by other rare-earth (RE) elements can enhance the structural stability of 2:14:1. The gains in cohesive energy are 0.75, 0.10, and 0.33 eV per formula unit in (La0.5RE0.5)2Fe14B with RE = Ce, Pr, and Nd, respectively. Stabilizing the 2:14:1 structure and mitigating the formation of soft magnetic structural defects or impurity phases such as α-Fe is necessary to develop La2Fe14B based magnet, which can be moderately achieved via partial substitution of La by other rare earth elements such as Ce, Pr, and Nd.

Staged Rehabilitation of Military Personnel as Part of a Multimodal Approach to the Gunshot Soft Tissue Defects Reconstruction

Aim: To increase the efficacy of the original staged scheme of wounded with soft tissues gunshot defects (STGD) rehabilitation using the original improvement of diagnostic and restorative rehabilitation measures. Materials and Methods: The wounded with STGD were admitted to the Military Medical Clinical Center of the Southern Region (Odesa). The wounded were randomized in three groups depending on the severity of the injury for further rehabilitation in sanatorium-resort conditions. Spectral infrared thermography diagnostic capabilities were used to control the efficacy of rehabilitation measures and to evaluate the rehabilitation prognosis. Results: The data obtained were divided into immediate clinical and delayed organizational ones with rapid implementation into the medical practice to support the military forces of Ukraine. Authors showed the full-fledged functional recovery of the patient’s injured limbs as a result of original step-by-step scheme applying of providing medical care in cases of STGD. Conclusions: Timely rehabilitation measures at all stages of providing medical care in the Armed Forces are faster and more effective. The organizational and methodological foundations of the staged rehabilitation system of wounded servicemen with STGD at different levels of medical care depending on the severity of the injury and the tactics of surgical treatment have been developed. Different three- and four-staged models of rehabilitation measures for the injured with different severity have been proposed.

ОКИСЛИТЕЛЬНЫЙ СТРЕСС И АНТИОКСИДАНТНАЯ СИСТЕМА ПРИ ТЯЖЁЛЫХ ТРАВМАХ ВЕРХНЕЙ КОНЕЧНОСТИ

Objective: To evaluate lipid peroxidation (LPO) and antioxidant defense (AOD) system in severe upper limb injury (SULI) with skin defects covered with autografts Methods: LPO and AOD system were evaluated in 32 patients after urgent surgical intervention for SULI. The patients were divided into two groups: Group I (main) included 16 patients who underwent reconstructive surgery and antioxidant therapy, and Group II included 16 operated patients who did not receive antioxidant treatment. There were 22 men and 10 women enrolled in the study; the age of the patients varied between 19-51 years, and the average age was 29.2 years. Patients of both groups underwent reconstructive surgery with soft tissue traumatic defects covered with autografts. In both groups, malondialdehyde (MDA) and superoxide dismutase (SOD) were tested in the blood serum before surgery and on the 7th day after surgery. In the main group, patients received a course of antioxidant treatment immediately in the postoperative period for 7 days, while the control group patients did not receive this therapy. Results: The MDA values before surgery in Groups I and II were similar comprising 3.23±0.41 and 3.35±0.37 µmol/l, respectively. After surgery, there was a considerable decrease in the level of MDA in both groups (p 0.001), however, in Group I this decrease was more significant compared to Group II (1.86±0.32 µmol/l vs. 2.78±0 .43 µmol/l, p 0.001). Initially, the level of SOD in both clinical groups had no statistical differences (p 0.05), amounting to 10.6±2.4 u/ml and 10.2±1.8 u/ml, respectively. The level of SOD on the 7th day after the operation tended to increase in both groups, however, its more significant increase was noted in the main group compared with the control group (15.8±1.3 u/ml and 12.2±1.9 u/ml, respectively, p 0.001). Conclusion: SULI with skin defects is accompanied by oxidative stress and antioxidants depletion. The use of antioxidant therapy in the postoperative period largely eliminates the disbalance in the LPO-AOD system and improves the results of reconstructive surgeries in SULI. Keywords: LPO, AOD, MDA, SOD, upper limb injury, autotransplantation, antioxidant therapy.

Prosthetic Rehabilitation of Completely Edentulous Unrepaired Cleft Palate Patient with Implant Supported Hader Bar and Clips: A Case Report

Prosthetic rehabilitation of an edentulous cleft lip and palate patient with a combined hard and soft palate defect is a great challenge, due to the lack of retention of the obturator prosthesis as a result of its weight and the inability to obtain a border seal. Dental implants improve the retention, stability, and occlusal function of prostheses when used in carefully selected cleft lip and palate cases. This clinical report presents an edentulous unilateral cleft lip and palate patient who has hard and soft palate defects and an atrophied maxilla, treated with an implant-supported speech-aid prosthesis Prosthetic rehabilitation of an edentulous cleft lip and palate patient with a combined hard and soft palate defect is a great challenge, due to the lack of retention of the obturator prosthesis as a result of its weight and the inability to obtain a border seal. Dental implants improve the retention, stability, and occlusal function of prostheses when used in carefully selected cleft lip and palate cases. The prosthetic rehabilitation of edentulous patient with unrepaired cleft palate poses a great challenge due to both hard and soft tissue defect compromising retention, support and stability of the obturator due to inability to obtain border seal and heavy weight. In carefully selected patient use of osseointegrated implant along with the bars and clips supporting and retaining maxillary overdentures on implants play a significant role in their efficacy. This clinical report presents an edentulous unilateral cleft palate patient treated with an implant-supported Hader bar and clips.

DEFINITIONS OF SURGICAL CARE TO WOUNDED WITH SOFT TISSUES DEFECTS GUNSHOT WOUNDS ON THE III AND THE IV LEVELS OF MEDICAL CARE MAINTENANCE DURING THE ATO/JFO

Relevance. The large number of wounded in modern military conflicts “encourages” and in some cases requires revision and modernization of previous views, concepts and theories of medical care providing to wounded during military operations. The optimal concept for the surgical care provision transformation to wounded with soft tissues gunshot defects is to change the approach and tactics of viewpoint at soft tissues gunshot defects which should tactically and strategically rely on the principles of reconstructive and restorative surgery which corresponds to NATO countries medical protocols.
 Objective: to establish the characteristics of the main and additional diagnostic and treatment schemes the content and volume of surgical care for the injured with soft tissues gunshot defects in the conditions of the III and IV levels of medical care providing in the Military Medical Forces of the Ukrainian Armed Forces.
 Materials and methods. 342 wounded were included into the study who were treated in the health care system of the Ukrainian Armed Forces from December 2016 to December 2021. 128 of them consisted the main group and 214 - the comparison group.
 The third level of medical support was formed and implemented at the operational level at the expense of surgical departments (clinics) of the Military Medical Clinical Centers of the Northern and Eastern Regions, medical institutions of the Ministry of Health of Ukraine and provided for the provision of specialized medical assistance: diagnosis of injuries and necessary inpatient treatment of the wounded with the aim of their fastest return to military units or referral to the fourth level of medical care.
 The fourth level of medical care (highly specialized treatment and rehabilitation) was formed and implemented at the strategic level on the basis of Military Medical Clinical Centers (National, Southern, Central and Western regions Region), research institutes of the National Academy of Sciences of Ukraine and provided for provision of highly specialized medical care using high-tech equipment and highly specialized medical procedures of high complexity.
 Results. In general, the experience of the Ukrainian Armed Forces medical support during ATO/JFO showed the high efficiency of specialized surgical treatment of the injured with soft tissues gunshot defects in highly specialized departments of treatment and prevention institutions of the IV level using the most effective diagnostic and treatment technologies. We believe that a similar transformation of medical care provision to the wounded took place due to the fact that, in accordance with the proposed and implemented differentiated surgical tactics with a multimodal approach to wounded with soft tissues gunshot defects reconstruction, new staffs of medical companies of brigades and battalion medical posts were proposed and approved during the JFO, the positions of riflemen were introduced paramedics of departments, combat medics of platoons, senior combat medics of companies.
 Taking into account the results obtained it should be noted that the system of medical care providing for the transition to a higher level should include:
 - the possibility of qualified medical assistance providing from the II level aimed at recovery, stabilization, and in some cases saving the life of a wounded serviceman on the basis of "damage control resuscitation" which meets the NATO protocols requirements;
 - available in terms of time and operational situation, the use of air evacuation for the purpose of wounded with gunshot defects of soft tissues, which demonstrates an increase in the rate of preservation of 20-25% of the volume of the damaged anatomical structure;
 - use of modern additional technologies in the form of dynamic digital thermography and audio doppler.
 Conclusions. The listed positions obtained during the surgical care implementation at the III-IV levels of medical care have demonstrated that the use of additional alternative portable technologies meets the requirements and conditions of a rapidly changing theater of operations in a modern military conflict.

Soft tissue features of peri-implant diseases and related treatment.

The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.

Saphenous Artery-based Posteromedial Leg Fasciocutaneous Flap for Knee Reconstruction.

Background:Soft tissue knee defects are frequently seen in surgical practice. The saphenous artery (SA)-based flap is a management option with variable suggested donor sites. The present study describes the use of an SA-based flap harvested from the posteromedial aspect of the leg in management of soft tissue knee defects.Methods:The present study recruited 30 patients with soft tissue knee defects due to miscellaneous causes. All patients were treated with an SA-based flap harvested from the posteromedial aspect of the leg. All patients were followed up for 6 months. Outcome parameters included flap survival, flap complications, and restoration of knee function.Results:After 6 months of follow-up, all flaps survived; the reported complications were distal flap necrosis (6.7%), wound dehiscence (6.7%), seroma (3.3%), and small contracture band (3.3%). All patients restored normal range of motion around the knee.Conclusion:An SA-based flap harvested from the posteromedial aspect of the leg is a feasible, safe, and effective option for management of soft tissue knee defects.

The "Kite-t-FAMMIF": A Novel Technique for Reconstruction of Extensive Soft Palate Resection.

Summary:Total soft palate reconstruction is a challenge for the head and neck surgeon. Velopharyngeal incompetence resulting from soft palate resection impairs both speech and swallowing and significantly affects the quality of life of the patients. Radial forearm free flap is the reconstructive technique most used worldwide, but it requires microsurgical skills, is associated with high donor site morbidity, and shrinks during the healing process, especially after adjuvant radiotherapy. We present a novel technique using a single “kite-shaped” tunnelized-facial artery myomucosal island flap (t-FAMMIF) and report very favorable functional outcomes. Three patients in whom a kite-shaped flap was used to reconstruct a total soft palate defect after squamous cell carcinoma resection were included. In two of them, the resection included both tonsils due to cancer spreading to the tonsillar fossae. The mucosal and muscular sides of a single t-FAMMIF flap were able to restore the oral and nasal lining of the palate, respectively, without the need to fold the flap. All patients were able to tolerate an oral soft diet 10 days after surgery. No complications were detected. A complete mucosalization on the nasal lining was observed by video-endoscopy 3 weeks after surgery. No case of shrinking of the flap was observed during the follow-up, and speech and swallowing functions were not impaired after complete wound healing. Kite-shaped t-FAMMIF represents an excellent and feasible reconstructive option for extensive postablative soft palate defects.

Fault identification model using IIoT for industrial application

To prevent substantial economic losses brought on by problems in rolling element bearings, Industrial revolution 4.0 detection methods have been revitalized by Artificial Intelligence (AI) and anIndustrialized Internet of Things (IIoT). Strategies in final devices have been challenged because diagnostic systems receive a range of inputs that provide variances in the input space. Normally, a two-way cross-domain training strategy was used to solve this problem. For the final devices, the researchers provide a soft real-time defect diagnosis technology that utilizes a training strategy to adapt the domain. Deep Learning (DL) patterns develop concepts independently of the input dimension used in the survey. A comparative study was done on a dataset accessible to determine the effectiveness of the proposed methodology with an average accuracy of 88.08%.Experimental results showed in an IIoT ecosystem and our proposed system using a short-term memory system provides the most accurate bearing detecting results.