Soft Tissue Components Research Articles

Pedicled anterolateral thigh flap: A versatile flap for complex regional defect reconstruction.

Soft-tissue defects of the lower abdomen, perineum, groin, and trochanteric area often involve the loss of composite tissue components and are technically challenging to reconstruct. The goals of reconstruction should include the replacement of the defect with a suitable soft-tissue flap that provides stable coverage while protecting important exposed structures. However, there are limited locations in this region for the creation of pedicled flaps for complex defect reconstruction. The pedicled anterolateral thigh (ALT) flap is considered superior to other comparable flaps due to its varying soft-tissue components and long pedicle with consistent anatomy that allow the reconstruction of locations that are difficult to reach without significant flap donor site morbidity. Herein, we present a case series of our experience of using a pedicled ALT flap to reconstruct regional defects over a range of locations. The present study comprised ten patients who underwent surgical reconstruction of soft-tissue defects of the lower abdomen, groin, trochanteric, scrotal, and penoscrotal defects using a pedicled ALT flap over a two-year period. The flap was customized according to the defect when required. In our case series, flap loss was not observed with only a few minor complications. All patients accepted the aesthetic appearance of the flap recipient site area without requesting revision surgery. The donor site was closed primarily in half of all cases, with split skin grafting applied in the remaining patients. Graft take at the flap donor site was satisfactory in all cases. A pedicled ALT flap is a reliable and suitable option for complex soft-tissue reconstruction for regional soft-tissue defects of the lower abdomen and perineum.

Current Radiotherapy Concepts Regarding Brain and Bone Metastases in Centers Participating in the German-Danish Interreg-Project TreaT.

Radiotherapy regimens for brain or bone metastases vary substantially. This study compared regimens utilized in Northern Germany and Denmark. Three centers participating in the Interreg-Project TreaT completed questionnaires regarding preferred radiotherapy regimens for brain or bone metastases. Brain metastases: In poor-prognosis patients, all centers prefer short-course whole-brain irradiation (WBI) for multiple metastases. For oligometastatic disease, two centers prefer WBI, one center fractionated stereotactic radiotherapy (FSRT). For single lesions, all centers use FSRT. In intermediate- or favorable-prognosis patients, longer-course WBI is preferred for multiple lesions, sometimes with simultaneous-integrated boost. For oligo-metastasis, regimens vary. FSRT is preferred for single lesions. Bone metastases: For poor-prognosis patients, single-fraction radiotherapy is used for uncomplicated metastases and short-course radiotherapy for (impending) fractures, large soft-tissue components, and spinal cord compression. Multi-fraction regimens are preferred for intermediate-prognosis and longer-course regimens for favorable-prognosis patients. Regimens are relatively similar for bone metastases, single and multiple brain lesions, but vary considerably for few brain metastases. Further cross-border collaboration is required to provide more uniform and optimized treatment standards.

Skeletal, Dentoalveolar and Soft tissue Components of Skeletal Class II Malocclusion among Nepalese Orthodontic Patients: A Cephalometric Study

Introduction: The understanding of the craniofacial morphology of skeletal Class II malocclusion is a key element in planning orthodontic treatment. The aim of this study was to describe various skeletal, dentoalveolar, and soft tissue components of skeletal Class II malocclusion in Nepalese orthodontic patients. Materials and Method: This cross-sectional study was carried out at the Universal College of Medical Sciences (UCMS) in the Department of Orthodontics and Dentofacial Orthopedics. Lateral cephalograms of 70 patients with skeletal class II malocclusion of age greater than 1 8 years, and ANB > 4°, were traced. Various skeletal, dentoalveolar, and softtissue measurements were taken. Descriptive statistics were performed followed by an independent sample t-test to find the difference in mean of various cephalometric parameters between males and females. Result: Among 70 subjects, 54 samples had class II div 1 malocclusion and 16 had class II div 2 malocclusion. Mandibular retrognathism was seen in 37 subjects having skeletal Class II Div 1 malocclusion and in 9 subjects with Class II Div 2 malocclusion. The mean value of SNA was 82.91 ° ± 2.87°, SNB was 76.81 ° ± 2.97°, and ANB was 6.11 ° ± 1.22° in Class II Div 1 subjects. In subjects with Class II Div 2, the mean value of SNA was 82.31 ° ± 3.19°, SNB was 76° ± 4.08°, and ANB was 5.44° ± 1.21 °. Mean value of U1 to NA degree and linear measurement was Class II div 1 was 28.30° ± 6.86° degree and 5.56 ± 2.76 mm respectively. Similarly, mean value of LI to NA degree and linear measurement was 31 .93° ± 5.96° and 6.16 ± 2.37 mm respectively. Mean and standard deviation value of upper lip to S-line and lower lip to S-line was 2.85 ± 2.1 3 mm and 3.54 ± 2.47 mm respectively in Class II Div 1 subjects. Similarly, in Class II Div 2 it was 1.50 ± 2.16 mm and 0.13 ± 2.66 mm respectively. Mean and standard deviation value of nasolabial angle was 93.69° ± 12.91° in Class II div 1 and 96.38° ± 12.26° degree in Class II Div 2. The mean values of most cephalometric parameters did not differ statistically between male and female subjects with Class II div 1 malocclusion. Conclusion: In subjects with skeletal Class II mean value of SNA was within normal range whereas SNB was decreased. Retrognathia and a small mandible in relation to the cranial base with a well-positioned maxilla were observed in the majority of subjects. Mean U1 to NA angular and linear measurement was increased in Class II Div 1, whereas they were decreased in Class II Div 2.

A rare case of sialolipoma of submandibular gland

<p class="abstract">Lipomas in head and neck region are common but prevalence in salivary glands is rare with majority in parotid. Sialolipoma is a rare tumour of the salivary gland that is composed of mature adipocytes and normal salivary gland tissue. We report an extremely rare case of sialolipoma of left submandibular gland in a 39-year-old male who presented with complaints of insidious onset gradually progressive swelling in left submandibular region with no pain, discolouration or discharge. On examination, a 5×4 cm soft, non-tender swelling was noticed in (L) submandibular region. Ultrasonography of neck revealed enlarged (L) submandibular gland with hypoechoic area of 5 mm diameter and small areas of echogenic foci with no cervical lymphadenopathy. Contrast enhanced computed tomography (CECT) neck showed a 5.6×2.7×4 cm well defined fat attenuated lesion in (L) submandibular space, suggestive of lipoma with a well-defined enhancing soft tissue component within the lesion. He underwent excision of (L) submandibular gland along with fibrofatty tissue under general anaesthesia. Histopathological examination revealed submandibular gland with normal histomorphological features along with mature adipocytes in fibrofatty tissue. The patient is on regular follow-up with no recurrence.</p><p class="abstract"> </p>

Transconjunctival internal decompression of the orbit in patients with endocrine ophthalmopathy: a retrospective analysis

BACKGROUND: The most characteristic manifestation of endocrine ophthalmopathy (EO) is the proptosis development in a patient. It is possible to correct the displacement of eyeballs by performing an orbital decompression surgery.
 AIM: To evaluate the clinical efficacy of treating patients with endocrine proptosis using transconjunctival internal decompression of the orbit.
 MATERIALS AND METHODS: The study included 86 orbits of 43 patients with bilateral proptosis. All patients underwent MSCT examination, proptosis was detected due to an increase in the soft tissue component. Transconjunctival decompression of both eye sockets was performed according to the described method, and the amount of eyeball displacement after surgery was investigated.
 RESULTS: Patients complaints about constant pressure behind the eye, observed in 39 patients, disappeared during the first day after surgery in 21 patients, in the remaining patients they gradually disappeared within a week. In 32 patients with preoperative diplopia after surgery, in 27 it completely disappeared, in the remaining 5 it remained in the extreme positions. 6 months after surgery, a decrease in proptosis amount from 21.1 1.5 mm to 20.6 1.5 mm was noted, visual acuity was 1.0 0.02, decreased visual acuity remained in 3 cases due to the incipient cataract, IOP decreased from 20 1.2 mm Hg to 19 1.3 mm Hg. There were no eyeball movement restrictions at the control examination.
 CONCLUSIONS: Internal (soft tissue) decompression of the orbit is an effective method for proptosis correction exophthalmos in patients with lipid EO form. Carrying out the decompression surgery through the conjunctival access allows to constantly monitor the shape and size of the pupil in the operated orbit, to conduct controlled hemostasis of the orbital tissues. The use of preliminary calculations of the volume of soft tissues to be removed (according to MSCT) makes it possible to obtain a predictable effect of the surgery in variable degrees of proptosis. Transconjunctival decompression helps avoiding cicatricial processes of the eyelid skin.

Quantitative Assessment of Breast-Tumor Stiffness Using Shear-Wave Elastography Histograms.

Purpose: Shear-wave elastography (SWE) measures tissue elasticity using ultrasound waves. This study proposes a histogram-based SWE analysis to improve breast malignancy detection. Methods: N = 22/32 (patients/tumors) benign and n = 51/64 malignant breast tumors with histological ground truth. Colored SWE heatmaps were adjusted to a 0-180 kPa scale. Normalized, 250-binned RGB histograms were used as image descriptors based on skewness and area under curve (AUC). The histogram method was compared to conventional SWE metrics, such as (1) the qualitative 5-point scale classification and (2) average stiffness (SWEavg)/maximal tumor stiffness (SWEmax) within the tumor B-mode boundaries. Results: The SWEavg and SWEmax did not discriminate malignant lesions in this database, p > 0.05, rank sum test. RGB histograms, however, differed between malignant and benign tumors, p < 0.001, Kolmogorov-Smirnoff test. The AUC analysis of histograms revealed the reduction of soft-tissue components as a significant SWE biomarker (p = 0.03, rank sum). The diagnostic accuracy of the suggested method is still low (Se = 0.30 for Se = 0.90) and a subject for improvement in future studies. Conclusions: Histogram-based SWE quantitation improved the diagnostic accuracy for malignancy compared to conventional average SWE metrics. The sensitivity is a subject for improvement in future studies.

Peripheral Odontogenic Keratocyst of Buccal Mucosa.

The odontogenic keratocyst is a developmental cystic lesion of jaw bones. There is an on-going debate about the pathogenesis of this entity. Odontogenic keratocysts are usually seen intraosseously in jaws with a predilection in the mandibular molar ramus regions. Extra-skeletal variants are reported rarely in the gingiva. Extra-skeletal variants occurring peripherally in other soft tissue components of the oral cavity are extremely rare. Even though histogenesis is ambiguous, such presentation may be related to the tumour-like behaviour of odontogenic keratocysts. Here, we present a case of peripheral odontogenic keratocyst in a 62-year male who presented with complaint of a painless lump on the right buccal mucosa. The diagnosis was made on biopsy of the lesion. The lesion was excised completely. Key Words: Buccal mucosa, Pathology, Keratocyst, Odontogenic.

Probing Local Force Propagation in Tensed Fibrous Gels.

Fibrous hydrogels are a key component of soft animal tissues. They support cellular functions and facilitate efficient mechanical communication between cells. Due to their nonlinear mechanical properties, fibrous materials display non-trivial force propagation at the microscale, that is enhanced compared to that of linear-elastic materials. In the body, tissues are constantly subjected to external loads that tense or compress them, modifying their micro-mechanical properties into an anisotropic state. However, it is unknown how force propagation is modified by this isotropic-to-anisotropic transition. Here, force propagation in tensed fibrin hydrogels is directly measured. Local perturbations are induced by oscillating microspheres using optical tweezers. 1-point and 2-point microrheology are combined to simultaneously measure the shear modulus and force propagation. A mathematical framework to quantify anisotropic force propagation trends is suggested. Results show that force propagation becomes anisotropic in tensed gels, with, surprisingly, stronger response to perturbations perpendicular to the axis of tension. Importantly, external tension can also increase the range of force transmission. Possible implications and future directions for research are discussed. These results suggest a mechanism for favored directions of mechanical communication between cells in a tissue under external loads.

Intraorbital Fixation Midface Lift.

Subperiosteal midface lift provides a comprehensive solution to the soft tissue component of midfacial aging. However, midfacial aging also has a skeletal component that is rarely addressed with conventional mid-facelift techniques. Moreover, many of the adverse outcomes after a mid-facelift are closely related to failures and limitations of mid-face fixation. The author's technique was designed to overcome these limitations. The author aimed to describe the rationale, technical details, and outcomes of the author's mid-facelift technique with intraorbital fixation. This study was a retrospective review of 82 nonconsecutive cases where the intraorbital fixation mid-facelift was performed by the author between September 2016 and December 2021. Patient data were obtained from patient records and standardized photography. Preoperative differences in mid-face volume were assessed utilizing the Allergan midface volume deficit scale on standardized photography. The average mid-face volume deficit score significantly improved after surgery. Failure of fixation, flat midface deformity, and relapse of mid-face ptosis were not seen in any of the primary patients. Infraorbital hollow did not recur in any of the patients operated on with this technique. None of the primary patients (0/58) in this series developed ectropion or permanent lower eyelid malposition. Intraorbital fixation mid-face lift is an effective and durable surgical option for the treatment of midfacial aging. The technique is applicable in problem cases such as negative vector patients, negative canthal tilt patients, male patients with large bags, and secondary lower blepharoplasties where conventional techniques tend to fail.

Tissue specific considerations in implementing high intensity focussed ultrasound under magnetic resonance imaging guidance.

High-intensity focused ultrasound can ablate a target permanently, leaving tissues through which it passes thermally unaffected. When delivered under magnetic resonance (MR) imaging guidance, the change in tissue relaxivity on heating is used to monitor the temperatures achieved. Different tissue types in the pre-focal beam path result in energy loss defined by their individual attenuation coefficients. Furthermore, at interfaces with different acoustic impedances the beam will be both reflected and refracted, changing the position of the focus. For complex interfaces this effect is exacerbated. Moreover, blood vessels proximal to the focal region can dissipate heat, altering the expected region of damage. In the target volume, the temperature distribution depends on the thermal conductivity (or diffusivity) of the tissue and its heat capacity. These are different for vascular tissues, water and fat containing tissues and bone. Therefore, documenting the characteristics of the pre-focal and target tissues is critical for effective delivery of HIFU. MR imaging provides excellent anatomic detail and characterization of soft tissue components. It is an ideal modality for real-time planning and monitoring of HIFU ablation, and provides non-invasive temperature maps. Clinical applications involve soft-tissue (abdomino-pelvic applications) or bone (brain applications) pre-focally and at the target (soft-tissue tumors and bone metastases respectively). This article addresses the technical difficulties of delivering HIFU effectively when vascular tissues, densely cellular tissues, fat or bone are traversed pre-focally, and the clinical applications that target these tissues. The strengths and limitations of MR techniques used for monitoring ablation in these tissues are also discussed.

Contrast-enhanced multidetector computed tomography features and histogram analysis can differentiate ameloblastomas from central giant cell granulomas.

BACKGROUNDNo qualitative or quantitative analysis of contrast-enhanced computed tomography (CT) images has been reported for the differentiation between ameloblastomas and central giant cell granulomas (CGCGs).AIMTo describe differentiating multidetector CT (MDCT) features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.METHODSMDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors. Histogram analysis was used to compare the extent of enhancement of the soft tissue. Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis (P < 0.05).RESULTSTwelve CGCGs and 33 ameloblastomas were reviewed. Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle. CGCGs were multilocular (58.3%), with a mixed lytic sclerotic appearance (75%). Soft tissue component was present in 91% of CGCGs, which showed hyperenhancement (compared to surrounding muscles) in 50% of cases, while the remaining showed isoenhancement. Matrix mineralization was present in 83.3% of cases. Ameloblastomas presented as a unilocular (66.7%), lytic (60.6%) masses with solid components present in 81.8% of cases. However, the solid component showed isoenhancement in 63%. No matrix mineralization was present in 69.7% of cases. Quantitatively, the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis (P < 0.05), with a minimum enhancement of > 49.05 HU in the tumour providing 100% sensitivity and 85% specificity in identifying a CGCG.CONCLUSIONA multilocular, lytic sclerotic lesion with significant hyperenhancement in soft tissue, which spares the angle of the mandible and has matrix mineralization, should indicate prospective diagnosis of CGCG.

X-RAY CHARACTERISTICS OF THE KNEE JOINTS IN PATIENTS WITH MONOGONATHROSIS

Introduction. The feasibility of X-ray examination in the diagnosis of gonarthrosis in the knee joint has been increasingly questioned in recent years due to the impossibility of visualizing soft tissue elements; instead, magnetic resonance imaging as a priority method of radiation diagnostics is considered as more appropriate. The goal of this study is to investigate the structural and functional state of the knee joints of patients with monogonarthrosis by comparing the findings obtained by standard X-ray and magnetic resonance imaging. Material and methods. Materials included clinical and radiological examination protocols of 125 patients (54 (43.2%) men and 71 (57.8%) women), aged from 18 - 79 years with monogonarthrosis. Research methods included the clinical assessment of orthopaedic status; X-ray diagnostics: X-ray examination of knee joints with the evaluation of qualitative and quantitative parameters of bone elements; magnetic resonance imaging with a study of the frequency of changes in soft tissues; biochemical investigation of blood serum with determining the C-reactive protein content, which was used as a serological marker of inflammation, and synovial fluid to assess the content of rheumatoid factor; obtained findings were processed statistically. Results and discussion. According to the results of the comprehensive examination, group A with primary monogonarthrosis (118; 94.4%) and group B with gray-positive unspecified rheumatoid monoarthritis (7; 5.6%) were identified. Group A was divided into 2 subgroups: seronegative A1 (71; 56.8%) with normal CRP content and seropositive A2 (47; 37.6%) with CRP &gt; 5 mg/l. Qualitative and quantitative X-ray signs of knee joints in the patients with monogonarthrosis grade 1-2 according to the Kellgren-Lawrence classification revealed asymmetry of the width of the condyles of the femur (81.6%) and tibia (86.4%), asymmetry of the joint space (89.6%) and discordance of joint surfaces (88.8%). MRI scans of the affected knee joint demonstrated a high frequency of synovitis (98.4%), hypertrophy of Hoff fat bodies (92.0%), degenerative lesions of the medial (22.4%) and both (65.6%) menisci, chondromalacia of the patella ( 68.8%), osteophytes (64%), and incomplete rupture of the anterior cruciate ligament (64.8%). In subgroups A1 and A2, the X-ray anatomical structure of the knee joints was almost identical without statistical difference in any of the studied parameters. Conclusion. Standard radiography of the knee joint in patients with monogonarthrosis enables to assess the anatomobiomechanical characteristics of the bone elements of the knee joint. According to the MRI results, it is possible to assess the state of the soft tissue components in the knee joint. These imaging techniques complement each other and, to some extent, help to predict the further course of the disease.

Virtual surgical planning and 3D printing in pediatric musculoskeletal oncological resections: a proof-of-concept description.

Patient-specific models may have a role in planning and executing complex surgical procedures. However, creating patient-specific models with virtual surgical planning (VSP) has many steps, from initial imaging to finally realizing the three-dimensional printed model (3DPM). This manuscript evaluated the feasibility and potential benefits of multimodal imaging and geometric VSP and 3DPM in pediatric orthopedic tumor resection and reconstruction. Twelve children with Ewing's sarcoma, osteosarcoma, or chondrosarcoma were studied. Computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) were acquired as the standard-of-care. Bony and soft tissue components of the tumor and the adjacent bone were segmented to create a computer-generated 3D model of the region. VSP used the computer-generated 3D model. The Objet350 Stratasys™ polyjet printer printed the final physical model used for pre-surgical planning, intraoperative reference, and patient education. Clinical impact, the utility of the model, and its geometric accuracy were assessed. Subjectively, using the patient-specific model assisted in preoperative planning and intra-operative execution of the surgical plan. The mean difference between the models and the surgical resection was -0.09mm (range: -0.29-0.45mm). Pearson's correlation coefficient (r) of the cross-sectional area was -0.9994, linear regression r2 = 0.9989, and the Bland Altman plot at 95% confidence interval showed all data within boundaries. We studied the geometric accuracy, utility and clinical impact of VSP and 3DPM produced from multi-modal imaging studies and concluded 3DPM accurately represented the patients' tumor and proved very useful to the surgeon in both the preoperative surgical planning, patient and family education and operative phases. Future studies will be planned to evaluate surgery procedure duration and other outcomes.

Two clinical cases of the reconstruction of distal phalanges of hand in children by combination of the regional flap and scrap bone and nailbed graft

BACKGROUND: The hand and its distal phalanges, especially in children, are among areas mostly exposed to trauma while contacting the environment. Injuries causing loss of soft tissue and bone component are both challenging and interesting. This report presents the treatment results of children with soft tissue and bone defects of distal phalanges, in which reconstructions including combination of regional flaps, bone, and nailbed grafts were performed.&#x0D; CLINICAL CASE: This report presents clinical cases of the surgical treatment of 4- and 6-year-old children with fingertip injuries who underwent reconstructions including the combination of regional flaps, bone, and nailbed grafts. A combination of the scrap graft was performed in the first case with antegrade homodigital island flap and in the second case with thenar flap. The results were assessed 6 and 7 months after surgery.&#x0D; DISCUSSION: The primary aim of the surgical treatment of children with distal phalangeal defects is coverage of those defects. The restoration of the bone component of the defect is recommended to prevent postoperative deformations of the distal phalanges. Fingertip replantation or microsurgical transplantation of vascularized tissue complexes are technically difficult and require thorough care and monitoring of the childs condition in the postoperative period as all these measures may fail.&#x0D; CONCLUSIONS: The possibility to combine the scrap bone and nailbed graft with existing reliable surgical methods open new prospects for the successful treatment of fingertip injuries.

Botanicals and Oral Stem Cell Mediated Regeneration: A Paradigm Shift from Artificial to Biological Replacement.

Stem cells are a well-known autologous pluripotent cell source, having excellent potential to develop into specialized cells, such as brain, skin, and bone marrow cells. The oral cavity is reported to be a rich source of multiple types of oral stem cells, including the dental pulp, mucosal soft tissues, periodontal ligament, and apical papilla. Oral stem cells were useful for both the regeneration of soft tissue components in the dental pulp and mineralized structure regeneration, such as bone or dentin, and can be a viable substitute for traditionally used bone marrow stem cells. In recent years, several studies have reported that plant extracts or compounds promoted the proliferation, differentiation, and survival of different oral stem cells. This review is carried out by following the PRISMA guidelines and focusing mainly on the effects of bioactive compounds on oral stem cell-mediated dental, bone, and neural regeneration. It is observed that in recent years studies were mainly focused on the utilization of oral stem cell-mediated regeneration of bone or dental mesenchymal cells, however, the utility of bioactive compounds on oral stem cell-mediated regeneration requires additional assessment beyond in vitro and in vivo studies, and requires more randomized clinical trials and case studies.

Thigh Pain In A Football Player

HISTORY: 15 year old football player presenting with left thigh pain for 2 weeks. No acute injury. Pain first noticed with running. Pain is sharp, rated 8/10 at rest. Despite relative rest, no improvement in symptoms; symptoms now present at rest. Does have nighttime pain. Denies radicular symptoms, fever, recent infection, weight loss. PHYSICAL EXAMINATION: MSK: Left Lower Extremity-Inspection: No swelling, deformity, ecchymosis. Antalgic gait. -Palpation: Tenderness over length of rectus femoris. There is no tenderness over the knee, hip, tibia, fibula. -Range of motion: Limited exam due to pain. -Neurovascular: Strength is 4+/5 in flexion. Distally neurovascularly intact with brisk pulses, 2 second capillary refill, and sensation intact to light touch. DIFFERENTIAL DIAGNOSIS: 1. Ewing Sarcoma 2. Osteosarcoma 3. Osteomyelitis 4. Langerhans Cell Histiocytosis TEST AND RESULTS: XR Left Femur:Findings: Focal area of cortical destruction at medial aspect of proximal tibial diaphysis. Adjacent cortex abnormal. Corresponding periosteal reaction, hyperdense soft tissue mass. No pathologic fracture. Impression:Aggressive lesion of proximal femoral diaphysis. Further evaluation with contrast-enhanced MRI recommended. Labs: CRP 2.9- > 8.9-> > 0.1, ESR 117- > 130-> > 2, WBC 8.9, Hgb/Hct 14/41.6, Plt 407CXR: negativeMRI Left Lower Extremity with/without contrast:Impression:1. Aggressive marrow replacing lesion of left femoral diaphysis with anterior projecting soft tissue component. Differential includes Ewing's sarcoma versus osteosarcoma. 2. No additional lower extremity osseous lesion or adenopathy identified. LEFT FEMUR BIOPSY:SPECIMEN: Fragments of reactive bone with mixed inflammation, compatible with osteomyelitis. REPEAT LEFT FEMUR BIOPSY: I&D; obtained additional tissue to r/o malignancy.Specimen: Findings consistent with acute and chronic osteomyelitis. No features of malignancy seen. FINAL/WORKING DIAGNOSIS: Acute on Chronic MRSA Osteomyelitis TREATMENT& OUTCOMES: 1. Admission for IV antibiotics. Febrile on admission; fever curve improved. 2. ID: Oral Antibiotics x 6 weeks. Improving pain, downtrending inflammatory markers until wnl. 3. Ortho: Toe Touch Weightbearing x 6 weeks - > PWB - > WBAT. Completed PT. Cleared for high impact/contact activities.

255P Challenges to assess bone metastases in Blinded Independent Central Review (BICR) of breast cancer trials using RECIST 1.1

The most common site of metastases in breast cancer patients is bone with reported incidence around 60–80 %. The skeletal metastases are associated with increased morbidity, but studies have noted a better overall survival compared to patients with visceral organ metastases. Imaging plays a key role in the diagnosis and assessment of bone metastases in clinical practice and trials. The commonly used RECIST 1.1 criteria recognize challenges of assessing bone metasteses. Bone lesions are mainly considered unmeasurable and qualitatively assessed, except in the presence of osteolytic lesions with measurable soft tissue component.

The prognosis of different types of pleural tags based on radiologic-pathologic comparison

ObjectivesThere are increasing numbers of studies of pleural tags (PTs). The purpose of this case series was to classify the PTs in patients with peripheral pulmonary adenocarcinoma based on radiologic-pathologic comparison and to study the prognosis.MethodsThe clinical, imaging, pathological and prognostic data of 161 patients with peripheral pulmonary adenocarcinoma in three hospitals were analyzed retrospectively. We classified PTs using computed tomography (CT) for pathologic comparison.ResultsAccording to the relationship between tumors and pleural on CT images, PTs were classified into four types: type 1, one or more linear pleural tag; type 2, one or more linear pleural tag with soft tissue component at the pleural end; type 3, one soft tissue cord-like pleural tag; type 4, directly abutting the visceral pleura, pulling or pushing the visceral pleura. In these PTs, the incidence of visceral pleural invasion (VPI) was high in type 2 (46.88%) and type 3 (56.41%) of PTs. Our prognostic analysis showed that micropapillary or solid histological subtype (HR = 5.766, 95% CI: 1.435–23.159, P = 0.014) and type 3 of PTs (HR = 11.058, 95% CI: 1.349–90.623, P = 0.025) were two independent risk factors for tumor progression.ConclusionsPT is a risk factor for poor prognosis in patients with peripheral pulmonary adenocarcinoma, the presence of which on CT images can remind us to provide patients with a more reasonable treatment.

Donor Site Morbidity and Quality of Life after Microvascular Head and Neck Reconstruction with a Chimeric, Thoracodorsal, Perforator-Scapular Flap Based on the Angular Artery (TDAP-Scap-aa Flap).

Extensive defects in the head and neck area often require the use of advanced free flap reconstruction techniques. In this study, the thoracodorsal perforator-scapular free flap technique based on the angular artery (TDAP-Scap-aa flap) was postoperatively evaluated regarding the quality of life and the donor site morbidity using the standardized SF-36 and DASH questionnaires (short form health 36 and disabilities of the arm, shoulder and hand scores). Over a five-year period (2016–2020), 20 selected cases (n = 20) requiring both soft and hard tissue reconstruction were assessed. On average, the harvested microvascular free flaps consisted of 7.8 ± 2.1 cm hard tissue and 86 ± 49.8 cm2 soft tissue components. At the donor site (subscapular region), only a mild morbidity was observed (DASH score: 21.74 ± 7.3 points). When comparing the patients’ postoperative quality of life to the established values of the healthy German norm population, the observed SF-36 values were within the upper third (>66%) of these established norm values in almost all quality-of-life subcategories. The mild donor site morbidity and the observed quality of life indicate only a small postoperative impairment when using the TDAP-Scap-aa free flap for the reconstruction of extensive maxillofacial defects.

Tumors of the Spine: When Can Biopsy Be Avoided?

Regarding osseous tumors of the spine, characteristic morphology is encountered in hemangioma of the vertebral body, osteoid osteoma (OO), osteochondroma, Paget's disease, and bone islands. In these cases, radiologic imaging can make a specific diagnosis and thereby avoid biopsy, especially when the radiologist has chosen the correct imaging modality to establish the diagnosis, such as thin-slice computed tomography in suspected OO. A benign lesion is suggested by a high amount of fat within the lesion, the lack of uptake of the contrast agent, and a homogeneous aspect without solid parts in a cystic tumor. Suspicion of malignancy should be raised in spinal lesions with a heterogeneous disordered matrix, distinct signal decrease in T1-weighted magnetic resonance imaging, blurred border, perilesional edema, cortex erosion, and a large soft tissue component. Biopsy is mandatory in presumed malignancy, such as any Lodwick grade II or III osteolytic lesion in the vertebral column. The radiologist plays a crucial role in determining the clinical pathway by choosing the imaging approach wisely, by narrowing the differential diagnosis list, and, when characteristic morphology is encountered, by avoiding unnecessary biopsies.