Use of Fish Skin Graft in Management of Combat Injuries Following Military Drone Assaults in Field-Like Hospital Conditions.

INTRODUCTION: The 2020 Nagorno-Karabakh war was an armed conflict between Azerbaijan and Armenia over an ethnically and historically significant region. This manuscript is a report on the forward deployment of acellular fish skin graft (FSG) from Kerecis™, a biologic, acellular matrix derived from the skin of wild-caught Atlantic cod that contains intact epidermis and dermis layers. The usual intention of treatment under adverse circumstances is to temporize wounds until better treatment can be attained, although ideally, rapid coverage and treatment are necessary to prevent long-term complications and loss of life and limb. An austere environment, such as the one experienced during the conflict described here, presents considerable logistical barriers for the treatment of wounded soldiers. MATERIALS AND METHODS: Dr H. Kjartansson from Iceland and Dr S. Jeffery from the United Kingdom traveled to Yerevan, near the heart of the conflict, to deliver and train on using FSG in wound management. The primary goal was to use FSG in patients where stabilization and improvement in the wound bed were needed before skin grafting. Other goals were to improve healing time, achieve earlier skin grafting, and have better cosmetic outcomes upon healing. RESULTS: Over the course of two trips, several patients were managed with fish skin. Injuries included large-area full-thickness burn and blast injuries. Management with FSG induced wound granulation several days sooner in all cases, and even weeks in some instances, allowing a stepdown in the reconstruction ladder with earlier skin grafting procedures and a reduction in requirement of flap surgery. CONCLUSIONS: This manuscript describes a successful first instance of forward deployment of FSGs to an austere environment. FSG, in this military context, has shown great portability, with easy transfer of knowledge. More importantly, management with fish skin has shown faster granulation rates in burn wounds for skin grafting, resulting in improved patient outcomes with no documented infections.

Chemical studies on the parasitic plant Thonningia sanguinea Vahl.

Thonningia sanguinea Vahl plays an important role in traditional medicine in many African cultures. A study of the n-hexane fraction of the whole plant of T. sanguinea led to the isolation of two glucocerebroside molecular species TSC-1 and TSC-2, one ß-sitosteryl-3ß-d-glucopyranoside-6'-O-fatty acid ester molecular species, TSS-1, and seven known triterpenes (1-7). The ethyl acetate fraction also afforded five known lignans (8-12) and one known flavanone (13). Their structures were elucidated by means of chemical and spectroscopic methods (methanolysis, NMR and mass spectrometry). Spectral analyses of the glucocerebrosides revealed mainly sphingosine-type (TSC-1) and phytosphingosine-type (TSC-2) cerebrosides, with both possessing mainly 2-hydroxy fatty acid and ß-d-glucopyranose moieties. TSS-1 was found to be a ß-sitosterol-type with fatty acid methyl esters and ß-d-glucopyranoside moieties. The classes of compounds isolated from this plant are well known for their interesting biological activities including antimicrobial, antioxidant, anticancer, antiinflammatory and analgesic. They may therefore be responsible in part or in whole for these activities, hence validating the traditional uses of the plant. To the best of our knowledge, this is the first report on the isolation of all these compounds from T. sanguinea.

Does the presence or position of lower third molars alter the risk of mandibular angle or condylar fractures?

PURPOSE: The purpose of this study was to determine whether a relation exists between the presence of mandibular third molars (M3s) and mandibular angle and condylar fractures and whether the risk of these fractures varies with M3 position. MATERIALS AND METHODS: A retrospective cohort study was conducted in patients with mandibular fractures presenting to the oral and maxillofacial surgery service from April 2007 to March 2012. Data sources were patients' hospital charts and panoramic radiographs. Predictor variables were the presence and position of M3s. M3 position was based on the Pell and Gregory classification and angulation was determined by measuring the angle between the long axis of the M3 and the mandibular occlusal plane. Outcome variables were the presence of angle and condylar fractures. Other study variables included age, gender, and fracture etiology. Data were analyzed using the χ(2) test and Student t test. RESULTS: The study sample consisted of 446 patients with 731 mandibular fractures. Results showed that the risk of mandibular angle fracture was significantly higher in patients and mandible sides with impacted M3s (P < .001), whereas the risk of condylar fracture was significantly higher in patients and mandible sides lacking impacted M3s (P < .001). A relation between the position of M3s to angle or condylar fractures could not be found (P > .05). CONCLUSION: The presence of impacted M3s increased the risk of angle fracture and simultaneously decreased the risk of condylar fracture. However, no relation appeared to exist between M3 position and fracture pattern.