Volumizing and Cogged Threads for Nose Augmentation.

BACKGROUND: Nose augmentation using nonsurgical methods, including volumizing and cogged threads, has gained popularity due to its minimally invasive nature, shorter recovery times, and reduced risks compared to traditional rhinoplasty. However, there is limited literature on the use of these techniques in the Asian population. AIMS: This study aims to present two successful cases of nose augmentation using volumizing and cogged threads, providing evidence of their effectiveness and demonstrating the insertion techniques through a supplementary video. PATIENTS/METHODS: Two female patients (aged 26 and 33) underwent nonsurgical nose augmentation. The first patient received volumizing threads to enhance nasal contour, while the second patient received cogged threads to refine the nasal tip and alar base. Both procedures were performed using polydioxanone (PDO) threads, with follow-ups conducted to assess the outcomes. RESULTS: Both patients exhibited significant improvement in nasal contour and projection, with outcomes maintained for up to 8 months post-procedure. The patients reported high satisfaction with the aesthetic results, and no complications were observed during the follow-up period. CONCLUSIONS: Volumizing and cogged threads offer a promising nonsurgical alternative for nose augmentation, particularly in patients seeking minimal invasiveness and natural-looking results. While the initial outcomes are positive, further research is needed to evaluate the long-term safety and effectiveness of these techniques, especially in the Asian demographic.

Non-circulatory arrest aortic arch replacement.

The definitive management of combined aortic arch and descending aortic pathologies such as aneurysms and dissections is either a single or staged operation associated with high morbidity and mortality. Stroke, kidney dysfunction, coagulopathy and high blood transfusion requirements are all affiliated with hypothermic circulatory arrest and prolonged cardiopulmonary bypass times. Considering the perilous nature of these operations, the authors describe a step-by-step zone 2 arch replacement as a staged frozen elephant trunk procedure, which provides an adequate landing zone for a later-placed endovascular stent yet maintains a short cardiopulmonary bypass time and no circulatory arrest.

Reaction-Driven Migration Dynamics of Nano-Metal Particles Unraveled by Quantitative Electron Microscopies.

The stability of supported nano-metal catalysts holds significant importance in both scientific and economic practice, beyond the long pursuit of enhanced activity. While previous efforts have concentrated on augmenting the interaction between nano-metals and carriers, in the thermodynamic macro-perspective, to achieve optimized repression upon particle migration coalescence and Ostwald ripening, nevertheless, the microscale kinetics of migrating catalyst particles driven by the reaction remains unknown. In this work, the migration of nano-copper particles is investigated during hydrogen oxidation reaction by utilizing high spatiotemporal resolution of environmental transmission electron microscopy. It is shown that there exists a delicate correlation between the migration dynamics of nano-copper particles and the evolution of asymmetrically distributed Cu and Cu2O phases over the particle surface. It is found that the interplay of reduction and oxidation near the surface areas filled with Cu and Cu2O phases can facilitate the pressure gradient, which drives the migration of nano-particles. A driving force model is therefore established which is capable of qualitatively explaining the influences of reaction conditions such as temperature and hydrogen-to-oxygen ratio on the reaction-driven particle migration. This work adds a potential yet critical perspective to understanding particle migration and thus the nano-metal catalyst particle sintering in heterogeneous catalysis.

The Arthroscopically Guided Bristow-Latarjet Procedure With Cortical Button Fixation: A Minimum 10-Year Follow-up.

BACKGROUND: Despite improved visualization, the use of arthroscopic surgery to perform the Latarjet procedure has not decreased the rates of complications and glenohumeral osteoarthritis (OA) in the long term. Many of the reported complications are related to the use of screws for bone block fixation with freehand drilling. PURPOSE: To evaluate the long-term (at a minimum 10-year follow-up) clinical and radiological outcomes of the arthroscopic Bristow-Latarjet procedure using a posterior guided drilling technique and suture button for coracoid bone graft fixation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive patients who underwent the arthroscopic Bristow-Latarjet procedure with suture button fixation between 2011 and 2013 were reviewed by 2 independent evaluators. Complications and revision surgery were recorded, and we evaluated patient-reported outcomes including subjective scores, recurrence of shoulder instability (dislocation or subluxation), range of motion limitations, and return to sports. Patients had radiographs taken at least 10 years after surgery to assess glenohumeral OA according to the Samilson-Prieto classification system and computed tomography scans to assess bone block positioning and healing. RESULTS: A total of 65 consecutive patients (68 shoulders) with a mean follow-up of 135 months (range, 120-156 months) were included. The mean age at the time of surgery was 25 ± 8 years; 7 patients had previous failed Bankart repair. At follow-up, 94% (64/68) of the shoulders had no recurrence of instability. The 4 cases of instability recurrence were traumatic and occurred at 3 weeks (a fall), 4 months, 2 years, and 7 years after surgery. No hardware failures, coracoid fractures, or neurological complications were observed. Overall, 61 patients (94%) were still participating in sports, with 44 (68%) at the same or higher level. Range of motion showed nonsignificant restrictions in external rotation with the arm at the side (7° ± 9°) and with the arm at 90° of abduction (9° ± 10°) compared with the contralateral side. Additionally, 11 shoulders (16%) had some residual anterior apprehension on clinical examination. At last follow-up, 77% (47/61) of the shoulders had no OA development or progression. Previous failed Bankart repair was a risk factor for the development of OA. Patients with OA had significantly lower Subjective Shoulder Value scores (79% vs 91%, respectively; P = .01) and decreased external rotation with the arm at the side (40° vs 65°, respectively; P = .001) compared with patients with no or little OA. CONCLUSION: The arthroscopically guided Bristow-Latarjet procedure with suture button fixation is a safe and durable surgical treatment method for recurrent anterior shoulder instability, allowing a high rate of return to sports without significant motion restrictions and no or little OA in the long term.

Enhancing Photoelectric Response of Self-powered UV and Visible Detectors Using CuO/ZnO NRs Heterojunctions.

Understanding the development and performance of UV photodetectors is crucial, given their extensive applications in both military and civilian sectors. The evolution of self-powered photodetectors, especially those based on heterojunction nanostructures, has demonstrated significant potential for enhancing both device efficiency and functionality. By exploring the effects of material composition and structural design, can optimize these devices for improved photoelectric response and energy efficiency. In this study, we prepared the CuO/ZnO NRs heterojunction photodetector on an ITO substrate to enhance photoelectric response of UV detectors. The fabrication process utilized the hydrothermal method and the spin coating technique. The effect of CuO concentration on the optical response of the photodetector under UV radiation at wavelengths of 405 nm and 385 nm was investigated. The samples were characterized using FESSEM, XRD, EDX, and UV-Vis spectra. The device is further distinguished by its standard I-V curves and photocurrent-time curves, which demonstrate the device's behavior under various light conditions. The prepared thin films are polycrystalline, with CuO layers displaying monoclinic phases and ZnO layers exhibiting a hexagonal wurtzite phase. All samples have the potential to exhibit photovoltaic properties and self-powered capabilities. Furthermore, the I-V curve confirms that the photocurrent mechanism of these junctions adheres to the recombination standard, in addition to demonstrating correction behavior. A sample with a CuO concentration of 0.1 M shows the highest photosensitivity, reaching 340,700%, and a photocurrent gain (Iph/Idark) of 3,408 when exposed to light irradiation at 405 nm. Additionally, it exhibits a rapid response time of 0.8 s.

Machine learning predictive modeling for condemnation risk assessment in antibiotic-free raised broilers.

The condemnation of broiler carcasses in the poultry industry is a major challenge and leads to significant financial losses and food waste. This study addresses the critical issue of condemnation risk assessment in the discarding of antibiotic-free raised broilers using machine learning (ML) predictive modeling. In this study, ML approaches, specifically least absolute shrinkage and selection operator (LASSO), classification tree (CT), and random forests (RF), were used to evaluate and compare their effectiveness in predicting high condemnation rates. The dataset of 23,959 truckloads from 2021 to 2022 contained 14 independent variables covering the rearing, catching, transportation, and slaughtering phases. Condemnation rates between 0.26% and 25.99% were used as the dependent variable for the analysis, with the threshold for a high conviction rate set at 3.0%. As high condemnation rates were in the minority (8.05%), sampling methods such as random over sampling (ROS), random under sampling (RUS), both sampling (BOTH), and random over sampling example (ROSE) were used to account for imbalanced datasets. The results showed that RF with RUS performed better than the other models for balanced datasets. In this study, mean body weight, weight per crate, mortality and culling rates, and lairage time were identified as the 4 most important variables for predicting high condemnation rates. This study provides valuable insights into ML applications for predicting condemnation rates in antibiotic-free raised broilers and provides a framework to improve decision-making processes in establishing farm management practices to minimize economic losses in the poultry industry. The proposed methods are adaptable for different broiler producers, which increases their applicability in the industry.

Laparoscopic Sugarbaker repair of parastomal hernia following radical cystectomy and ileal conduit: a single-center experience.

PURPOSE: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. METHODS: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. RESULTS: Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25-38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. CONCLUSION: Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.

High-Dose-Rate Brachytherapy in Cervical and Endometrial Cancer Patients: A Retrospective Study From a Tertiary Cancer Center in the UAE.

Purpose This study evaluates the therapeutic outcomes and practical application of high-dose-rate (HDR) brachytherapy in managing cervical and endometrial cancers at a tertiary hospital in the UAE, focusing on treatment efficacy, safety, and patient-reported outcomes. Methods A retrospective analysis was conducted on 368 female patients treated between January 2008 and January 2022. Data included demographic information, cancer type, histopathology, treatment details, and survival outcomes. Statistical analyses were performed using descriptive and inferential statistics. Results The cohort comprised 275 cervical cancer patients (74.73%) and 93 endometrial cancer patients (25.27%). The majority were non-nationals (79.62%). The mean age was 57 years. Squamous cell carcinoma was the most common histopathological type (63.59%). HDR brachytherapy was administered to 290 patients (79.89%). The 12-month survival probability was significantly higher in the HDR-Brachy group (75%, 95% CI: 60% to 85%) compared to the noHDR-Brachy group (50%, 95% CI: 35% to 65%), with a hazard ratio of 0.953 (p=0.0035). At the last review, 86.68% of patients were alive, and disease progression was observed in 37.88% of patients. Conclusion HDR brachytherapy significantly improves survival outcomes in cervical and endometrial cancer patients. Continued efforts to enhance access and standardize brachytherapy protocols are essential to optimize treatment efficacy and patient outcomes in similar healthcare settings.

Meta-regression of idiopathic full-thickness macular holes diameter and anatomical closure rate: Implications to intraoperative technique.

Purpose: Primary surgery failure of macular holes causes poor visual acuity outcomes. Several studies indicate that small-medium idiopathic full-thickness macular holes (iFTMH) have consistent and high anatomical closure rates after vitrectomy and internal limiting membrane (ILM) peeling, regardless of iFTMH diameters. However, there is no systematic analysis examining the relationship between iFTMH diameters and anatomical closure rates. Methods: In this systematic review and meta-regression, we searched PubMed, Embase, and Web of Science databases on October 24th, 2022. We included studies regarding iFTMH, with ILM peeling/inverted flap technique, long-lasting gas tamponade, and face-down position after surgery. Univariable meta-regression with a restricted cubic spline model and component-plus-residual plot after covariables adjustment were used to explore non-linear association. Results: A total of 7257 participants from 19 randomized controlled trials and 49 observational studies were included in this meta-analysis. In ILM peeling group, every 100-µm increment in diameter was associated with a 3.8 % (95 % confidence interval [CI], 1.8%-5.7 %, P < 0.001) relatively lower anatomical closure rate. Yet, among studies using the inverted flap technique, baseline iFTMH diameter was not associated with a lower anatomical closure rate (0.2 %, 95%CI, -4.2 %-4.5 %, P > 0.9). The restricted cubic spline model and component-plus-residual plot controlling for age, sex, and symptom duration prior to surgery showed no evident non-linearity in both surgical techniques. Conclusions: The iFTMH diameter is linear and inversely associated with the anatomical closure rate after the ILM peeling technique, but not with the inverted flap technique. The present study supports the use of advanced techniques, e.g., inverted flap technique, in small-medium iFTMH to improve anatomical closure rates.

Successful revascularization of the occluded anterior tibial artery using ultrasound-guided puncture of the occluded dorsal pedal artery: A case report with literature review.

A bidirectional approach is necessary for treating critical limb ischemia with complex, multiple lesions. We report an ultrasound-guided bidirectional puncture through an occluded vessel to treat an obstruction extending from the anterior tibial artery to the dorsal foot artery in a patient with toe gangrene and rest pain. This technique effectively restored arterial patency and is a promising approach for managing challenging critical limb ischemia occlusions.

The relationship between back handspring step out performance and take-off technique in female gymnasts.

Although the back handspring step out (BHS) is a foundational skill in balance beam routines, it can be performed using different take-off techniques. Back injuries are highly prevalent in the BHS due to the combination of high spine extension and joint loading. However, it is unclear which technique minimises injury risk or leads to better BHS performance. The purpose of the study was to identify techniques used for the BHS take-off and analyse the resulting BHS performance. Gymnasts were found to use either: Simultaneous Flexion-trunk and knees flex at the same time; Sequential Flexion-trunk reaches its maximum flexion followed by knee flexion; or Double-Bounce-knees and trunk both flex and then the knees extend and flex again. To assess performance, point deductions were calculated, and dynamic balance, ground reaction forces (GRFs) and relevant joint angles were analysed. The techniques had no differences in point deductions or dynamic balance, but there were differences in GRFs, spine extension and knee flexion. The Sequential Flexion technique had the lowest spine extension, which potentially reduces back injuries and the lowest knee flexion, which is a BHS requirement. These results support the use of Sequential Flexion technique when performing the BHS.

Augmented pathogen detection in brain abscess using metagenomic next-generation sequencing: a retrospective cohort study.

Brain abscess is a severe infection characterized by the accumulation of pus within the brain parenchyma. Accurate identification of the causative pathogens is crucial for effective treatment and improved patient outcomes. This 10-year retrospective, single-center study aimed to compare the detection performance of conventional culture methods and metagenomic next-generation sequencing (mNGS) in brain abscess. We reviewed 612 patients diagnosed with brain abscess and identified 174 cases with confirmed etiology. The median age was 52 years, with 69.5% males. Culture tests predominately identified gram-positive bacteria, particularly Streptococcus spp. Gram-negative bacteria, including Klebsiella spp., were also detected. However, mNGS revealed a more diverse pathogen spectrum, focusing on anaerobes (e.g., Fusobacterium spp., Parvimonas spp., Porphyromonas spp., Prevotella spp., and Tannerella spp.). mNGS exhibited significantly higher overall pathogen-positive rates in pus samples (85.0% vs 50.0%, P = 0.0181) and CSF samples (84.2% vs 7.9%, P < 0.0001) compared to culture. Furthermore, the detection rates for anaerobes displayed a notable disparity, with mNGS yielding significantly higher positive detections in both pus samples (50.0% vs 10%, P = 0.0058) and CSF samples (18.4% vs 0%, P = 0.0115) when compared to culture methods. The assistance of mNGS in pathogen detection, particularly anaerobes in brain abscess, was evident in our findings. mNGS demonstrated the ability to identify rare and fastidious pathogens, even in culture-negative cases. These results emphasize the clinical value of mNGS as a supplement for brain abscess, enabling more comprehensive and accurate pathogen identification.IMPORTANCEThe accurate identification of pathogens causing brain abscess is crucial for effective treatment and improved patient outcomes. In this 10-year retrospective study, the detection performance of conventional culture methods and metagenomic next-generation sequencing (mNGS) was compared. The study analyzed 612 patients with brain abscess and confirmed etiology in 174 cases. The results showed that culture tests predominantly identified gram-positive bacteria, while mNGS unveiled a broader diverse pathogen spectrum, particularly anaerobes. The mNGS method exhibited significantly higher overall rates of pathogen positivity both in pus and cerebrospinal fluid (CSF) samples, surpassing the culture methods. Notably, mNGS detected a significantly higher number of anaerobes in both pus and CSF samples compared to culture methods. These findings underscore the clinical value of mNGS as a supplement for brain abscess diagnosis, enabling more comprehensive and accurate pathogen identification, particularly for rare and fastidious pathogens that evade detection by conventional culture methods.

Induced membrane technique for malignant bone tumours of the humerus.

PURPOSE: The aim of this study was to report on mid- to long-term results following large humeral tumoral resection and reconstruction with the induced-membrane technique in skeletally immature patients suffering from primary malignant bone tumours. METHODS: A retrospective analysis identified all children who underwent the two stages of a humeral reconstruction using the induced-membrane technique for primary malignant humerus tumours between 2002 and 2020. Functional assessment was conducted by an independent observer using the Musculoskeletal Tumor Society (MSTS) scoring system for the upper limb. Radiological assessment was performed by two independent observers and the healing index was calculated (i.e., months/cm). RESULTS: Eight adolescents (5 osteosarcomas and 3 Ewing sarcoma), with a mean age of 14.2 years (SD = 2.7), were included. The mean length of the bone resection was 17.4 cm (SD = 3.8), and the mean delay of the resection and reconstruction stages was 9.4 months (SD = 4). The mean follow-up was 6.6 years (SD = 4.3). The mean MSTS score was 77.4% and the global average healing index was 1.04 months/cm (SD = 2.2). Four complications (i.e., prominence device, fracture, aseptic pseudarthrosis, radial palsy) and one local recurrence were observed in four patients, requiring four unplanned surgical procedures in three patients. One patient died fourteen years after the initial treatment due to a lung recurrence. CONCLUSION: The induced-membrane technique is an effective and safe alternative for reconstructing large humeral bone defects after tumour resection in adolescents. Although this is a two-stage technique, it gives good functional results comparable to other strategies found in the literature. LEVEL OF EVIDENCE: IV.

Encapsulation of Hydrophobic-but-Not-Lipophilic Perfluoro Liquids Based on a Self-Assembled Double Emulsion Template via Solvent Evaporation Method.

The facile encapsulation of perfluoro liquids that are hydrophobic but not lipophilic into liposomes or microcapsules presents a significant challenge in the fields of biomedicine, dynamic optics, functional chemical applications, etc. This is due to their chemical inertness and physical immiscibility, particularly those with low boiling points. In this study, a novel strategy based on a double emulsion template via solvent evaporation is proposed after investigating the mechanism of three-phase emulsion systems. The perfluoro liquid droplets can be easily emulsified into a polymer solution as the second emulsion layer, where the polymer shell is formed during solvent evaporation in the continuum medium under proper processing controls. The morphology of particles is predictable and fits well with the linear model derived from Neumann's triangle in three-phase systems. Furthermore, a comprehensive study on the encapsulation of perfluoro ketone, which is widely used as a green fire extinguisher agent, is conducted as an example. The encapsulated perfluoro ketone showed instant thermal response upon heating while maintaining a good shelf life at room temperature. The remarkable fire suppression performance exhibited great potential for practical applications. This work offers more insight into the encapsulation of "naughty" perfluorinated chemicals and provides more possibilities for extended applications.

A new method for identifying elastic parameters of isotropic materials based on square specimens.

This paper proposes a new impulse excitation technique using a square plate. First, the functional relationship between the modal frequency of the specimen and the geometrical dimensions and mechanical parameters was established by using the finite element method. Then, the continuous functional relationship derived by a homotopy method allowed the frequency ratios to be related to the thickness-to-length ratio and Poisson's ratio. By measuring the frequency ratios and thickness-to-length ratio, Poisson's ratio could be calculated using this functional relationship. When the density and Poisson's ratio were known, Young's modulus could be identified inversely in conjunction with the finite element analysis. Finally, a comparison test between this method and the traditional impulse excitation technique was designed and implemented, and the results showed that this method has advantages in both testing efficiency and accuracy. The study provides a new idea for system identification, which has important application value and promotion significance.

Synthetic and theoretical study on novel N-ylidic complexes of mercury as new antibacterial agents.

The novel structure of Hg(II) complexes including the pyridinium ylide C5H5NCHC(O)C6H4-m-Br (Y) were synthesized and reported in this study. In the first step, the pyridinium salt C5H5NCH2C(O)C6H4-m-Br (S) was produced by reacting 2,3'-dibromoactophenone and pyridine. then, treatment of S with K2CO3 gave the related pyridinium ylide Y. Finally, the reaction of Y with HgX2 and Hg(NO3)2·H2O leads to the formation of novel binuclear [HgY2][HgX4] (X=Cl (1); X=Br (2); X=I (3)) and polymeric [HgY(NO3)2]n (4) complexes. The structure of complex 2 was also determined by X-ray diffraction analysis. The obtained analyses proved the coordination through the ylidic carbon to metallic center. Additionally, Natural Bond Orbital (NBO), Energy Decomposition Analysis (EDA), and EDA-NOCV studies are also used to investigate the nature of metal-ligand bonding in the complexes. Finally, the antibacterial activity of 1-4 was also examined against Gram positive and negative represented significant levels of inhibitory potency respected to used standards.

Application of tissue pneumoperitoneum technique around lymph nodes in thoracoscopic lung cancer resection.

Background: Thoracoscopic surgery is a primary treatment for lung cancer, with lobectomy and mediastinal lymph node dissection being the predominant surgical approaches for invasive lung cancer. While many thoracic surgeons can proficiently perform lobectomy, thorough and standardized lymph node dissection remains challenging. This study aimed to explore a safer and more efficient surgical method for mediastinal lymph node dissection in lung cancer. Methods: A prospective randomized controlled study was conducted, involving 100 patients with right lung cancer who were admitted to our hospital from January 2021 to April 2024 and met the inclusion criteria. These patients were randomly divided into an observation group (tissue pneumoperitoneum technique around lymph nodes group) and a control group (conventional surgery group). Thoracoscopic lobectomy and mediastinal lymph node dissection were performed. Intraoperative and postoperative related indicators were observed to validate the effectiveness and safety of the tissue pneumoperitoneum technique around lymph nodes. Results: The observation group showed a significantly shorter lymph node dissection surgery time compared to the control group, with a statistically significant difference (p < 0.05). The number of lymph nodes dissected in the observation group was significantly higher than that in the control group, with a statistically significant difference (p < 0.05). Although the observation group had slightly more mediastinal lymph node stations dissected than the control group, the difference was not statistically significant (p > 0.05). The total drainage volume within three days postoperatively was comparable between the two groups, with no statistically significant difference (p > 0.05). The observation group had shorter chest tube indwelling time and postoperative hospital stay than the control group, with statistically significant differences (p < 0.05). The incidence of surgical complications was similar between the two groups, and there were no perioperative deaths. Conclusion: The tissue pneumoperitoneum technique around lymph nodes is a more efficient method for mediastinal lymph node dissection in lung cancer, demonstrating safety and feasibility, and is worthy of promotion.

Laparoscopic resection of giant adrenal myelolipoma: A case report with review of literature.

Giant adrenal myelolipoma (AML) may cause severe symptoms. In contrast to the previous reports, laparoscopy may play a pivotal role in the management of giant AML. This report aims to discuss a case of giant AML managed successfully by laparoscopy. A 63-year-old male was found to have a giant (12 × 10 × 8 cm) left AML during a workup for left lower chest pain on imaging. laparoscopic excision of a left adrenal gland with the lesion was performed under general anesthesia. The patient was discharged from the hospital after 3 days uneventfully. AML is a benign tumor that is characterized by the presence of adipose tissue and hematopoietic elements. Myelolipomas are typically asymptomatic. AML diagnosis is based on imaging and blood workup. Small asymptomatic AML is usually managed conservatively, while symptomatic AML is managed with surgery. Even though an open approach is the standard option, laparoscopy, as a minimally invasive technique, in some centers may replace laparotomy. Laparoscopy can be a successful method for managing AML, even when they are large in size.

Masquelet Technique Combined with Ilizarov External Fixator, Reamer-irrigator-aspirator, and Flap Transplantation in an Open Tibial Fracture: A Case Report.

Introduction: The induced membrane technique was initially described by Masquelet in 1986 as a treatment for tibia non-union. It then became an established method in the management of bone defects.A critical bone defect is defined by a gap larger than 25 mm, and so, has a higher probability of non-union. Many techniques have been described to resolve this problem such as segmental bone transport, free vascular fibula graft, non-vascular fibula graft, autogenous graft, or megaprothesis. Case Report: We present the case of a 37-year-old woman who presented a multi-fragmentary open fracture of the tibia and fibula bilaterally (Gustilo-Anderson III) after a high-velocity car accident. Conclusion: The aim of this article is to demonstrate that the use of a hybrid procedure combining the Masquelet technique with the Ilizarov external fixator and reamer-irrigator-aspirator can be an effective way to treat bone defect in an open tibial fracture classified as a Gustilo-Anderson III.

Heterotopic Ossification of the Achilles Tendon in a Patient with Type II Diabetes Mellitus: A Case Report and Comprehensive Management Overview.

Introduction: Heterotopic ossification of the Achilles tendon (HOTA) is a rare but consequential complication to an inflammatory event, often presenting challenges in diagnosis and management. Case Report: We report a case of a 42-year-old male with Type II diabetes mellitus, managed with Metformin, who presented with acute pain and swelling in the right ankle following a running activity. Clinical examination revealed tenderness and a visible swelling proximal to the calcaneum attachment of the tendon which was hard in consistency, and a positive Thompson test indicative of a potential Achilles tendon injury. Imaging, including X-ray and magnetic resonance imaging, confirmed a complete avulsion tear with cranial retraction of the torn tendon and heterotopic ossification seen proximal to the torn end of the tendon. Surgical intervention, employing a posterior paramedian approach under tourniquet control, involved tendon approximation using the Speed bridge technique, incision over the proximal tendon and removal of the ossified tendon, and repair of the incised tendon sheath. Postoperatively, the patient received a tailored medication regimen and was advised strict non-weight-bearing measures, wound management, and limb elevation. The patient was discharged in a stable condition. Conclusion: This case underscores the importance of early recognition and prompt surgical intervention in managing HOTA, particularly in patients with underlying risk factors. The presented surgical approach and postoperative management contribute to the evolving strategies for addressing this rare clinically significant condition.