Soft Tissue Damage Research Articles

Hyperbaric Oxygen Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma: A Prospective Study.

Background Non-union,chronic pain,functionaldisability, and infectionare all things that have been associated with open fractures with severe soft tissue damage leading to the need for additional hospitalization, and sometimes even subsequent surgeries and weeks or months of rehabilitation. Open fractures and severe musculoskeletal injuries are occasionally treated with hyperbaric oxygen therapy (HBOT) in an effort to reduce the risk of complications and increase the likelihood of a successful recovery. Methods A prospective randomized controlled study was done between January 2019 and August 2022 at a tertiary health care center including 60 patients with a severe soft tissue injury (Grade II and III) divided into two groups - group-CT (30 patients who received conventional treatment) and group HT (30 patients, who received HBOT in addition to conventional treatment). The outcome was measured according to the Bates-Jensen Wound Assessment Tool. Results The wound size, depth, and granulation were significantly reduced in group-HT patients. In the final session, the patient's severity of the wound in group-HT was significantly reduced (P = 0.0001) compared to group-CT. Conclusions Patients who received HBOT reported a significant improvement in their wounds.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement.

Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT. The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.

FORENSIC MEDICAL ASPECTS OF LARYNGEAL INJURY SEVERITY IN PATIENTS EXAMINED AT SPECIALIZED HOSPITAL

Closed blunt trauma to the larynx often necessitates forensic medical examination. This study aimed to evaluate the severity of laryngeal injuries in a forensic medical context based on examinations of patients treated in a specialized otolaryngology clinic in order to provide additional diagnostic criteria. Medical records from 56 patients with laryngeal injuries, who sought medical aid at Kharkiv Municipal Clinical Otolaryngological Hospital No. 30 over the past decade, were analyzed. Additionally, we conducted laryngostroboscopy on 16 patients at this institution.&#x0D; Results revealed that in 47 cases (83.9%), blunt force from hard objects (blows with fists or other objects) to the neck was the primary cause of laryngeal trauma. In 9 cases (16.1%), injuries resulted from neck compression by hands or blunt objects. Laryngostroboscopy allowed objective assessment of post-traumatic changes in laryngeal cases as well as contributed in substantiating the final results and detecting the duration of the health disorder. The severity of laryngeal injuries in a forensic medical context was determined from inpatient observation data. Severe injuries with life-threatening consequences were identified in 5.3% of cases. In 14.3% of cases, injuries were assessed as moderate, typically associated with cartilage fractures and did not pose life-threatening risks. Simple physical injuries causing short-term health disorders constituted 60.7% of cases, primarily involving soft tissue damage (swelling, hemorrhages, vocal cord hemorrhages). In 19.6% of cases, injuries were classified as minor, manifesting as acute post-traumatic laryngitis with no significant morphological changes.&#x0D; We can conclude that additional diagnostic criteria for assessing laryngeal injuries in a forensic medical context include the presence of morpho-functional changes in the larynx, as confirmed by laryngostroboscopy, along with considerations of life-threatening conditions. The results of this study enable to elaborate detailed steps for enhancing forensic medical examinations related to these specific injuries.

Retrograde tibial intramedullary nail versus minimally invasive locking plate for extra-articular distal tibial fractures: A comparative and retrospective study

BackgroundThe fractures of distal tibia represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for these fractures remains a considerable debate. This study was to perform a comparative analysis of retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) for extra-articular distal tibial fractures. Patients and methodsBetween December 2019 and December 2021, a retrospective review was conducted on 48 patients who sustained extra-articular distal tibial fractures. Patients underwent either RTN or MIPO procedures. Operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and related complications were recorded and compared between the two groups. ResultsNo statistically differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, one instance of implant failure, two occurrences of deep infection, and an additional three cases of superficial infection. The complications rate was remarkably higher in the MIPO group. ConclusionBoth RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of reduced hospital stay duration, faster return to full weight-bearing capacity, and a lower rate of complications.

Results of the transition from posterolateral to anterior minimally invasive approach for total hip arthroplasty

BackgroundThe anterior minimally invasive (AMI) approach reduces soft tissue damage, risk of dislocation and enhances recovery, but it is associated with certain complications. The aim of this study is to compare the outcomes of patients who underwent total hip arthroplasty (THA) through posterolateral (PL) and AMI approaches performed by the same surgeon, in order to determine the learning curve associated with this new approach.MethodsThis retrospective cohort study included patients who underwent THA via PL and AMI approach between 2017 and 2022, with a minimum follow-up of 1 year. Hip fracture and oncologic patients were excluded. Demographic variables, functional scores and perioperative complications were assessed. A bivariate analysis was performed to identify differences between groups.ResultsData of 124 AMI and 120 PL patients were analyzed. Demographic characteristics among groups were homogeneous. Functional outcomes at 3 months were superior for AMI (Oxford: 43 vs. 38; p < 0.05), no dislocations were identified (0% vs. 4.2%; p < 0.05) and no differences in the transfusion rate were found (6.5% AMI vs. 6.7% PL; p = 0.996). Infection rate was 4% for AMI and 3.4% for PL (p = 0.572). Surgical time was shorter for the PL approach, but the median surgical time of the last 25 AMI cases was shorter.ConclusionsThe AMI approach is an excellent alternative for patients requiring THA. Although surgical time and perioperative bleeding were greater during the learning curve, this approach offers improved functional outcomes and a lower dislocation rate, without significant differences in transfusion and infection outcomes, demonstrating that responsible innovation and safe implementation of new techniques is possible.

Overview and Prevention of Complications During Biportal Endoscopic Lumbar Spine Surgery

Unilateral biportal endoscopic spine surgery (UBESS) is a minimally invasive surgical technique that has gained popularity for its potential benefits in various spinal lesions. It involves 2 small incisions, providing wide and clear endoscopic visualization, and causes less soft tissue damage than open surgery. UBESS offers flexibility and versatility in approaching different spinal disorders, including decompression of the spinal cord and root in the cervical or thoracic spine, as well as lumbar discectomy and spinal stenosis. One of the strengths of UBESS is its similarity to microscopic techniques, allowing for 2-handed endoscopic surgery. This familiarity makes it easier for surgeons to adopt endoscopic techniques and overcome the learning curve associated with spine endoscopy. However, some potential complications are associated with biportal endoscopic spine surgery, including dural tear, epidural hematoma, infection, incomplete surgery, and neural injury. Although the overall incidence of these complications is relatively low, it is important for clinicians to be aware of them and understand preventive methods.

A comparative study of Ilizarov ring fixators and limb reconstruction system fixators in the treatment of compound tibial shaft fractures

Background: Tibia is the most commonly fractured long bone, and the prevalence of compound fractures has risen due to an increase in high-energy traumatic incidents. In addressing challenging tibial fractures with significant soft tissue damage, infected tibial nonunion, and compound tibial fractures, medical professionals have turned to specialized treatments, such as Ilizarov ring fixators and limb reconstruction system fixators. These fractures typically cannot be managed effectively with traditional internal fixation methods. To facilitate early weight-bearing, limb lengthening, and efficient wound care, two minimally invasive fixation systems have been developed: the Limb Reconstruction System and the ring fixator. Methods: The study was conducted on 40 patients with compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators with the aim to evaluate the functional outcome, union rate and amount of limb lengthening using Ring and ILRS fixators in compound tibial fixators. Results: In our study, a significant portion of the participants fell within the age range of 28 to 37 years, comprising 45% of the total sample. Furthermore, the majority of the study subjects were male, constituting 65% of the participant pool. The primary mode of injury reported in our study was road traffic accidents, accounting for 77.5%. Conclusions: The study concluded that LRS fixators show good and promising results like easy to apply, carry, compress, distract and clean while Ilizaro ring fixator is technically demanding, difficult to carry and cumbersome to the patient.

Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population

BackgroundPurpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. MethodThis study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. ResultsTotal of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70–66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04–2578.09, p = 0.011). ConclusionGunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. Level of evidenceLevel IV, Case series

The use of tourniquet is useful in terms of blood loss and soft tissue damage in arthroscopic anterior cruciate ligament reconstruction: a retrospective study

Whether a tourniquet should be used for anterior cruciate ligament reconstruction (ACLR) when the operative field is secured remains controversial. Little is known about the influence of not using a tourniquet on total perioperative blood loss and soft tissue damage. The aim of this study was to compare total perioperative blood loss and soft tissue damage with and without tourniquet use during ACLR. Seventy-seven consecutive ACLRs in 76 patients were performed without tourniquet use at our hospital and enrolled in this study (T− group) between November 2018 and September 2021. The control group (T + group) comprised 55 historical ACLRs in 55 patients performed with tourniquet use at our hospital between April 2017 and September 2018. Total perioperative blood loss, calculated from the change in hemoglobin between that preoperatively and on postoperative day (POD) 1, and indicators of soft tissue damage including serum white blood cell (WBC) counts, creatine phosphokinase (CPK), and C-reactive protein (CRP) values measured on POD 1 and POD 7 were compared between groups. Total blood loss was significantly higher in the T− group (339 ± 216 mL) than in the T + group (258 ± 199 mL; P = 0.030). On POD 1, WBC counts were significantly higher in the T− group (9.7 ± 2.4 × 103 cells/µL) than in the T + group (9.1 ± 2.5 × 103 cells/µL; P = 0.043), CPK levels were significantly higher in the T− group (294 ± 417 U/L) than in the T + group (255 ± 88 U/L; P = 0.046), and CRP levels were also significantly higher in the T− group (1.40 ± 1.12 mg/dL) than in the T + group (0.91 ± 0.76 mg/dL; P = 0.016). No significant differences in WBC counts or CPK or CRP levels were seen between groups on POD 7. Total blood loss and soft tissue damage were significantly increased without tourniquet use during ACLR. No advantage was found for not using a tourniquet in terms of blood loss or soft tissue damage.

Cross-Limb Vascular Shunting for Traumatic Popliteal Artery Injury

Popliteal artery injury (PAI) is a challenging trauma that requires prompt and accurate treatment since the probability of lower-limb amputation increases with the ischemic time. Intravascular shunting (IVS) and cross-limb vascular shunting (CLS) are used as temporary vascular shunting (TVS) methods to shorten the ischemic time for limb vascular injury. CLS involves sending blood from an artery in a healthy body part to a peripheral vessel in an injured part to immediately resume blood flow to the injured limb. For closed injuries including PAI, CLS may be performed without exploring and identifying the arterial stumps and it enables early reperfusion to the ischemic limb. We report the cases series of traumatic PAI treated using CLS and verify the usefulness of CLS. All patients with traumatic PAI treated with CLS at our institution between August 2013 and December 2021 were included. Demographic and clinical patient characteristics were extracted from the medical records. Comorbid injuries, severity of acute limb ischemia based on Rutherford grading scale, time from injury to reperfusion by CLS, time from injury to completion of artery, and the use of fasciotomy were investigated. As outcomes, we investigated the presence or absence of lower extremity amputation during the course of treatment. We used CLS for treatment for 5 cases with traumatic PAI. Based on the Rutherford grading scale for acute limb ischemia, there were one limb with grade 2B and four with grade 3. Amputation of the lower extremities was avoided except for one extremity in which arterial reconstruction was not achieved due to unexplained cardiac arrest during surgery. CLS enables early reperfusion of the injured limb and is effective as a TVS method for traumatic PAI with severe ischemia or soft tissue damage.

Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients.

Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2-78.4) and BMI of 26.7 kg/m2 (24.6-29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre-post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen's d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen's d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6-93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.

Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis.

The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.

Multidrug-resistant bacterial colonisation in Ukrainian war injuries: a need for multimodal therapy

This case report describes the interdisciplinary treatment of a complex shrapnel injury to the right femur of an 18-year-old Ukrainian soldier. This open multifragmentary fractur of the femur with a large bone defect, soft tissue damage and osteomyelitis was complicated by several multidrug-resistant bacteria, including Acinetobacter baumanii, which could not be eradicated by antibiotic treatment. Sterility was only achieved by multiple radical debridement and by negative pressure wound therapy with instillation (NPWTi) using hypochlorous acid. The femur was then reconstructed with a chimeric double-barrel fibula free flap. This report highlights the importance of multimodal antimicrobial wound treatments in an era of increasing antibiotic resistance to enable a successful und functional reconstruction of complex and infected fractures.

Metallosis in Total Hip Arthroplasty.

» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.

PENG block associated with dexmedetomidine sedation for intramedullary femoral fixation in high-risk elderly patients: a case series and review of the literature.

Hip fracture is a major cause of hospitalization among the elderly population. The standard surgical treatment involves early repair to reduce mortality and morbidity. One type of treatment in the case of intertrochanteric and subtrochanteric fractures is intramedullary nailing, as it decreases soft tissue damage and permits early weight bearing. The most common anesthesia technique combines spinal anesthesia with a peripheral block. In cases where spinal anesthesia is contraindicated, general anesthesia is preferred. However, both techniques can lead to significant complications, especially in patients with multiple comorbidities. Pain management after hip surgery, particularly in elderly and frail individuals, poses a challenge. The pericapsular nerve group block (PENG) targets the innervation of the anterior portion of the hip joint and is increasingly used for pain management related to hip surgery. This paper presents a case series of three elderly patients who underwent pericapsular nerve group block (PENG) block combined with dexmedetomidine sedation for intramedullary femoral fixation. The PENG block can be effectively used as the sole anesthetic technique for managing elderly patients undergoing intramedullary femoral fixation while on antiplatelet drugs. This procedure effectively controlled pain during both the surgical and postoperative periods. The addition of dexmedetomidine for sedation enables comfortable and safe procedures, minimizing the risk of perioperative neurocognitive dysfunctions and without adverse effects on cardiorespiratory function.

Usefulness of a drill stopper to prevent iatrogenic soft tissue injury in orthopedic surgery

ObjectiveThis study introduces a novel technique utilizing a drill stopper to limit drill penetration depth and to prevent iatrogenic injuries, specifically neurovascular damage, in orthopedic surgeries. Orthopedic surgeries frequently involve the use of drills, which are essential tools for various procedures. However, improper handling of drills can lead to iatrogenic soft tissue injuries, causing severe consequences such as permanent disability or life-threatening complications. To address this issue, we propose the use of a drill stopper as a safeguard to prevent excessive drill penetration and reduce the risk of soft tissue damage during surgery. Materials and MethodsThe study involved 32 orthopedic surgeons, half of whom were experienced and the other half inexperienced. Synthetic femur bone models (Synbone) were used for drilling exercises, employing four configurations: a sharp drill bit without a stopper (SF, Sharp Free), a sharp drill bit with a stopper (SS, Sharp Stopper), a blunt drill bit without a stopper (BF, Blunt Free), and a blunt drill bit with a stopper (BS, Blunt Stopper). Each participant conducted three trials for each configuration, and the penetration depth was measured after each trial. ResultsFor experienced surgeons, the average penetration depths were 3.83 (±1.826)mm for SF, 11.02 (±3.461)mm for BF, 2.88 (±0.334)mm for SS, and 2.75 (±0.601)mm for BS. In contrast, inexperienced surgeons had average depths of 8.52 (±4.608)mm for SF, 18.75 (±4.305)mm for BF, 2.96 (±0.683)mm for SS, and 2.83 (±0.724)mm for BS. ConclusionThe use of a drill stopper was highly effective in controlling drill penetration depth and preventing iatrogenic injuries during orthopedic surgeries. We recommend its incorporation, particularly when using a blunt drill bit or when an inexperienced surgeon operates in an anatomically unfamiliar area. Using the drill stopper, the risk of severe injuries from excessive drill penetration can be minimized, leading to improved patient safety and better surgical outcomes.

A Tremor Suppression and Noise Removal Algorithm for Microscopic Robot-Assisted Cataract Surgery

Ophthalmic surgery consists of a series of precise manipulations performed using a surgical microscope. A surgical robot with a master–slave paradigm is commonly adopted to improve the precision and guidance intelligence for ophthalmic surgery; however, the surgeon's hand tremor, misoperation, inherent characteristics of the robot, and environmental interference may cause tremors of the end-effector of the surgical manipulator, thus increasing the risk of soft tissue damage and poor prognosis for the patient. A symmetrical threshold noise reduction combiner (STIC) is proposed to suppress hand tremors and reduce environmental noise interference. Additionally, the inverse kinematic model of the eight-degrees-of-freedom surgical robot for cataract surgery is developed, with the constraints of continuous circular capsulorhexis manipulation. Simulation results show that the signal-to-noise ratio of the STIC is increased from 35.3907 to 57.0158 dB, whereas the maximum, average, standard deviation, and root mean square of the output of the STIC are decreased by 64.79%, 77.24%, 74.50%, and 75.86%, respectively. Three sets of in vitro experimental results show that these four indicators of the STIC performance are reduced by 59.73%, 76.57%, 57.23%, and 65.02%, respectively. These results validate the feasibility and effectiveness of the proposed method on hand tremor suppression and inherent high-frequency disturbance elimination, thereby enhancing the accuracy of the microsurgical operation.

Ipsilateral Concurrent Knee Arthroplasty and Tibial Osteotomy with 3D-Printed Patient-Specific Instrumentation: A Case Report.

A 70-year-old woman presented with knee pain and instability and was diagnosed with advanced knee osteoarthritis and bifocal tibial deformities. The complexity of the case challenged our team to perform a significant sagittal correction (>60°) and restore her ability to walk independently. We performed ipsilateral total knee arthroplasty and anterior closed wedge tibial osteotomy using virtual planning and 3D-printed patient-specific instrumentation. Using 2 separate 3D-printed patient-specific cutting guides for this patient with a complex deformity and managing the whole planning process in close collaboration between the surgeons and engineers resulted in a satisfactory postoperative outcome, optimal implant positioning and leg alignment, and minimal soft-tissue damage.

Treatment of Soft Tissue Defects after Minimally Invasive Plate Osteosynthesis in Fractures of the Distal Tibia: Clinical Results after Reverse Sural Artery Flap.

Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.

Design and fabrication of gelatin-based hydrogel loaded with modified amniotic extracellular matrix for enhanced wound healing

Trauma can damage the structural integrity of skin leading to its function being affected. There is an urgent clinical need for innovative therapeutic wound dressings. However, several challenges persist despite the current demands. The development and application of functional dressings offer a novel approach to address skin and subcutaneous soft tissue defects. Amniotic membrane as an ideal biological multifunctional material covering wound surface has been reported in clinic. However, current clinical applications of amniotic membrane still have limitations, such as thinness and mechanically weak. In this paper, we employed decellularized human amniotic membrane (dHAM) as a bioactive extracellular matrix (ECM) and modified it through methacrylate (MA) grafting for engineering purposes, resulting in the photosensitive dECMMA. Subsequently, we utilized a photosensitizer to achieve photopolymerization of dECMMA with GelMA hydrogel, successfully creating a novel composite hydrogel termed dECMMA/GelMA. This composite hydrogel not only inherits the favorable physicochemical properties of hydrogels but also maintains comparable levels of bioactivity to dHAM itself, supporting cell proliferation, migration, angiogenesis, and retaining significant anti-inflammatory capacity.Additionally, we evaluated the reparative effect of the designed dECMMA/GelMA composite hydrogel on rabbit wound defects. We demonstrated that the dECMMA/GelMA promoted wound healing and re-epithelization. These findings highlight the substantial benefits and therapeutic potential of the dECMMA/GelMA composite hydrogel as a practical solution for clinical applications in the treatment of soft tissue damage. Furthermore, this research provides a new strategy for designing and manufacturing bioactive dressings with exceptional clinical efficacy in the future.