Limb salvage surgery reconstructive techniques following long-bone lower limb oncological resection: a systematic review and meta-analysis.

BACKGROUND: Limb salvage surgery (LSS) is now considered the gold standard surgical treatment for lower limb bone sarcomas. However, there is a paucity of literature comparing the various LSS reconstructive options. The aim of this systematic review and meta-analysis was to compare functional outcomes and complications of LSS reconstructive techniques. METHODS: The primary aim of the meta-analysis was to determine functional outcomes from the pooled data utilizing the Musculoskeletal Tumour Society score (MSTS). Comparisons could then made for this outcome between biological and prosthetic, vascularised and non-vascularised, and prosthetic and composite reconstructions. The secondary aim was to compare complication outcomes of each reconstruction. Standardized mean difference (Cohen's d) and odds ratios were estimated using a random effects model. RESULTS: Fourteen studies with a total of 785 patients were included. We found structural failure was 75% less likely to occur in prosthetic reconstruction compared to biological (OR = 0.24; 95% CI: 0.07-0.79; P = 0.02). We did not find any evidence of difference in function (MSTS score) between vascularised verses non-vascularised reconstructions (Cohen's d = -1.14; 95% CI = -3.06 to 0.78; I2  = 87%). Other analyses comparing complications found no difference between the reconstructive groups. CONCLUSION: The study found no correlation between functional outcomes and the type of LSS reconstruction. Structural failure was more likely to occur in biological when compared with prosthetic reconstruction. There was no correlation between the incidence of other complications and the type of LSS technique. This suggests a role for improved approaches to reconstruction methods including bioprinting and bioresorbable devices.

Anterolateral thigh versus pectoralis major flaps in reconstruction of the lateral temporal bone defect.

BACKGROUND: Free tissue reconstruction is reliable in suitable patients but patient selection remains a challenge for the reconstructive surgeon. The anterolateral thigh (ALT) free flap and pedicled pectoralis major myocutaneous flap (PMMF) are two common reconstructive options for a lateral temporal bone resection defect. The threshold at which free tissue reconstruction should be considered over locoregional reconstruction is not defined. We sought to define reconstructive flap choice in the setting of medical comorbidities that may dissuade free tissue transfer. METHODS: A retrospective analysis of lateral temporal bone defects at a single institution was undertaken. The primary outcomes were flap survival, surgical complications and durations of surgery and stay. Data regarding medical comorbidities and potential confounders were examined. RESULTS: Sixty patients with lateral temporal bone defects were identified. Twenty-four (40%) patients underwent PMMF reconstruction and 36 (60%) were reconstructed with ALT. The former were significantly older (73 versus 62 years), though with similar Anesthesiologists Risk Classification System status. Free-flap reconstruction resulted in significantly less flap loss (two versus six) but a longer operating time (790 versus 671 min). CONCLUSION: Patients suffering head and neck cancer with medical comorbidities can make selection of a suitable reconstruction difficult. We found that while patients undergoing ALT reconstruction were typically younger, the comorbidity profile of those patients was similar to patients undergoing PMMF reconstruction. ALT flaps were more reliable than the PMMF, lending credence to the view that free tissue transfer should be the preferred reconstructive option in suitable candidates and defects.

Mouthguard biosensor with telemetry system for monitoring of saliva glucose: A novel cavitas sensor.

We develop detachable "Cavitas sensors" to apply to the human oral cavity for non-invasive monitoring of saliva glucose. A salivary biosensor incorporating Pt and Ag/AgCl electrodes on a mouthguard support with an enzyme membrane is developed and tested. Electrodes are formed on the polyethylene terephthalate glycol (PETG) surface of the mouthguard. The Pt working electrode is coated with a glucose oxidase (GOD) membrane. The biosensor seamlessly is integrated with a glucose sensor and a wireless measurement system. When investigating in-vitro performance, the biosensor exhibits a robust relationship between output current and glucose concentration. In artificial saliva composed of salts and proteins, the glucose sensor is capable of highly sensitive detection over a range of 5-1000µmol/L of glucose, which encompasses the range of glucose concentrations found in human saliva. We demonstrate the ability of the sensor and wireless communication module to monitor saliva glucose in a phantom jaw imitating the structure of the human oral cavity. Stable and long-term real-time monitoring (exceeding 5h) with the telemetry system is achieved. The mouthguard biosensor will be useful as a novel method for real-time non-invasive saliva glucose monitoring for better management of dental patients.