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Abdominoplasty is one of the most common plastic surgery procedures used to improve the appearance and contour of the abdominal region. Despite advances in surgical techniques, achieving optimal aesthetic results with minimal scarring remains a challenge. In this study, we describe a feasible approach to incision marking in abdominoplasty using a three-dimensional-printed incision marking tool. This technique with open source nature has the potential to revolutionize the field of plastic surgery and enhance patient satisfaction. Further studies are needed to confirm our findings and explore the potential applications of three-dimensional printing technology in other aesthetic procedures.
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Herein, we report an unusual presentation of a 38-year-old heathy lady with a painless slowly growing lesion in the volar aspect of her left distal forearm reaching the thenar area for >15 years. Magnetic resonance imaging of the lesion showed multilobulated soft tissue mass with low and high signal in T1- and T2-weighted images with homogenous contrast enhancement. Additionally, a stable serpiginous bony lesion was noted in the first metacarpal bone showing low T1 and high T2 signals with peripheral enhancement. Histopathological examination was consistent with cylindroma and enchondroma, respectively. The patient had full recovery with no recurrence at a 1-year follow-up visit. While enchondroma is the most common benign tumor of the hand, sporadic dermal cylindroma, in contrast, rarely affects the upper extremity. The coexistence of these two pathological entities was not previously reported and it may complicate the diagnosis.
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INTRODUCTION AND IMPORTANCE: Polydactyly of the hand is a common anomaly among pediatrics, which can present in conjugation with other syndromes or on its own. Various types can be seen, ranging from the involvement of skin only to a completely formed digit. We report the first case of pacifier type thumb duplication presenting with VACTERL association. Herein, we also summarize the existing literature of the distinctive features and management of pacifier polydactyly. CASE PRESENTATION: A premature male infant with intrauterine growth restriction due to maternal type II diabetes was referred for a soft tissue attachment to the left hand. The infant showed VACTERL association signs, including a single kidney, small atrial septal defect, and ventricular septal defect. Examination revealed preaxial polydactyly with a cystic swelling connected to the palm. CLINICAL DISCUSSION: Preaxial polydactyly is the second most common congenital hand anomaly, and its pathology is thought to involve the disruption of apoptosis during embryonic development. Pacifier-type polydactyly is a unique variation characterized by severe edema of the soft tissue digit, believed to be caused by physical damage in utero. The case presented did not require surgical intervention as the duplicated thumb underwent spontaneous autoamputation as opposed to other cases in the literature. CONCLUSION: This is the first reported case of pacifier-type thumb duplication in a patient with VACTERL association. The presentation of this condition adds to the existing body of literature on VACTERL association. Surgical removal is the treatment of choice for pacifier polydactyly, but spontaneous resolution can occur.
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This systematic review and meta-analysis aimed to summarize the current evidence regarding the association between coronavirus disease 2019 (COVID-19) vaccination and the risk of cardiac arrhythmia. MEDLINE, via PubMed and OVID, Scopus, CENTRAL, and Web of Science were searched using the relevant keywords to identify the relevant citations. Comprehensive Meta-analysis and Review Manager 5.4.1 were used for all the statistical analyses. Seventeen studies (n = 567,033,087 patients) were included. The pooled analysis showed that the incidence of cardiac arrhythmia post-COVID-19 vaccination with Pfizer, Moderna, AstraZeneca, CoronaVac, and Sinopharm was 0.22%, 95% CI: (0.07% to 0.66%), 0.76%, 95% CI: (0.04% to 12.08%), 0.04%, 95% CI: (0.00% to 0.98%), 0.01%, 95% CI: (0.00% to 0.03%), and 0.03%, 95% CI: (0.00% to 18.48%), respectively. Compared to CoronaVac, Pfizer, Moderna, AstraZeneca, and Sinopharm had a higher incidence ratio rate (IRR; 22-times, 76-times, 4-times, and 3-times higher), respectively. Likewise, Pfizer, Moderna, and AstraZeneca showed a higher IRR than Sinopharm (7.3-times, 25.3-times, and 1.3-times higher). The current evidence shows that the incidence rate (IR) of cardiac arrhythmia post-COVID-19 vaccination is rare and ranges between 1 and 76 per 10,000. mRNA vaccines were associated with a higher IR of arrhythmia compared to vector-based vaccines. Inactivated vaccines showed the lowest IR of arrhythmia.
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We present a digital workflow for the production of custom facial orthosis used for burn scar management using smartphone three-dimensional (3D) scanner and desktop 3D printing. 3D facial scan of a 48-year-old lady with facial burn scars was obtained. 3D modeling with open-source programs were used to create facemask then 3D printed using rigid polylactic acid (PLA) filament and semi-rigid thermoplastic polyurethane (TPU). Conventional facemask was used as a control. Each mask was worn for 7 days. Primary outcomes were level of comfort, and adherence to treatment. The conventional facemask was the most convenient followed by the TPU-facemask (mean comfort score of 9/10 and 8.7/10, respectively). Patient's compliance was high for both TPU and conventional masks, each was worn for at least 21 hours/day for 7 days. On the contrary, PLA-facemask was not well tolerated. The proposed digital workflow is simple, patient-friendly and can be adopted for resource-intensive healthcare.
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The advancement in therapy has provided a dramatic improvement in the rate of recovery among cancer patients. However, this improved survival is also associated with enhanced risks for cardiovascular manifestations, including hypertension, arrhythmias, and heart failure. The cardiotoxicity induced by chemotherapy is a life-threatening consequence that restricts the use of several chemotherapy drugs in clinical practice. This article addresses the prevalence of cardiotoxicity mediated by commonly used chemotherapeutic and immunotherapeutic agents. The role of susceptible genes and radiation therapy in the occurrence of cardiotoxicity is also reviewed. This review also emphasizes the protective role of antioxidants and future perspectives in anticancer drug-induced cardiotoxicities.
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The COVID-19 pandemic needs no introduction at present. Only a few treatments are available for this disease, including remdesivir and favipiravir. Accordingly, the pharmaceutical industry is striving to develop new treatments for COVID-19. Molnupiravir, an orally active RdRp inhibitor, is in a phase 3 clinical trial against COVID-19. The objective of this review article is to enlighten the researchers working on COVID-19 about the discovery, recent developments, and patents related to molnupiravir. Molnupiravir was originally developed for the treatment of influenza at Emory University, USA. However, this drug has also demonstrated activity against a variety of viruses, including SARS-CoV-2. Now it is being jointly developed by Emory University, Ridgeback Biotherapeutics, and Merck to treat COVID-19. The published clinical data indicate a good safety profile, tolerability, and oral bioavailability of molnupiravir in humans. The patient-compliant oral dosage form of molnupiravir may hit the market in the first or second quarter of 2022. The patent data of molnupiravir revealed its granted compound patent and process-related patent applications. We also anticipate patent filing related to oral dosage forms, inhalers, and a combination of molnupiravir with marketed drugs like remdesivir, favipiravir, and baricitinib. The current pandemic demands a patient compliant, safe, tolerable, and orally effective COVID-19 treatment. The authors believe that molnupiravir meets these requirements and is a breakthrough COVID-19 treatment.
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Antivirales/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Citidina/análogos & derivados , Descubrimiento de Drogas , Hidroxilaminas/uso terapéutico , SARS-CoV-2/efectos de los fármacos , Administración Oral , Animales , Antivirales/administración & dosificación , Antivirales/química , Ensayos Clínicos como Asunto , Citidina/administración & dosificación , Citidina/química , Citidina/uso terapéutico , Humanos , Hidroxilaminas/administración & dosificación , Hidroxilaminas/química , Patentes como Asunto , ADN Polimerasa Dirigida por ARN/metabolismo , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Inhibidores de la Transcriptasa Inversa/química , Inhibidores de la Transcriptasa Inversa/uso terapéutico , SARS-CoV-2/enzimología , Proteínas Virales/antagonistas & inhibidores , Proteínas Virales/metabolismoRESUMEN
Microtia reconstruction using autologous costal cartilage can be one of the most challenging tasks in reconstructive surgery. An intraoperative guide using 2-dimentional drawing of the contralateral ear on an x-ray film remains the current standard of care. In this paper, we present the use of computer-aided design and desktop 3D printing to fabricate low cost, sterilizable auricular carving templates to serve as a peri-operative reference for microtia reconstruction. The design was made as a single component which incorporated the usual anatomic reference points of the ear based on Nagata technique as a Stereo-lithography file format (. STL) for 3D printing. The templates were created in sizes ranging from 55 mm to 70 mm with a 2 mm increment with an average production cost of 0.26 US dollars per material per template and about 4.5 US dollars for the whole set. Individual templates were then 3D-printed using a thermoplastic polyurethane (TPU 95A) semiflexible filament on a desktop fused deposition modeling, Ultimaker 2 + 3D printer. The produced template tolerated the sterilization process with no structural changes as compared to its pre-sterilization condition. In conclusion, we present cost-effective, sterilizable, multiscale auricular templates to guide the pre- and intra-operative carving of the cartilaginous framework during microtia reconstruction with more accuracy in a time efficient manner, thereby overcoming the drawbacks of using the traditional x-ray film. The templates are readily accessible and sharable for free through open-source software and can be directly 3D-printed using an affordable desktop 3D printer.
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BACKGROUND: Myelomeningocele is the most common phenotype of congenital neural tube defects. Various reconstructive techniques have been described for soft tissue coverage following myelomeningocele repair, one of which is the use of dorsal intercostal artery perforator based flaps. The aim of this study was to describe our experience with the use of a transverse-oblique back flap that can be reliably extended to the anterior axillary line for closure of myelomeningocele defect. This pedicle transposition flap is based on thoracic or lumbar paraspinal perforators that originate from the dorsal intercostal arteries. METHODS: This is a retrospective two center case-series where all patients who underwent myelomeningocele defect closure with extended transverse-oblique flap over three years period were included. Patients' clinical data, surgical variables, and outcomes were documented and analyzed using descriptive measures. Flap harvest technique is also delineated in the present study. RESULT: Ten newborns (7 baby girls and 3 baby boys) who underwent a surgical closure of the myelomeningocele defect with an extended transverse-oblique back flap during the first week of life were included in the analysis. The defect was most commonly located in the lumbosacral area (50%) followed by the lumbar area (40%), with an overall average surface area of 22 ± 8.32 cm2. Common encountered complications include venous congestion to the distal part of the flap and minor wound dehiscence of less than 0.5 cm, all were managed conservatively. There were no incidences of flap loss or full necrosis. Primary closure of the donor site was possible in all cases. CONCLUSIONS: In the current series, the extended transverse-oblique back flap provided a safe and reliable coverage for myelomeningocele defect. Such a flap does not jeopardize other regional fasciocutanous or musclocutaneous flaps that might be needed for soft tissue coverage later in life for this population. It also obviates the placement of skin suture line over the repaired neural tube, thus yielding a durable coverage with no major complications or functional disability.
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BACKGROUND: Microsurgical anastomosis is a technically demanding skill. The most difficult part of the learning process was in achieving the necessary orientation and dexterity. In this project, we adopted computer-aided design and desktop 3D-printing in the development of an affordable training model with different levels of vessel orientation and angulation. METHODS: The training model was designed using CAD software (Rhino3D). The models were then 3D-printed with a thermoplastic polyurethane (TPU 95A) semiflexible filament on a desktop fused deposition modeling, Ultimaker 2 + 3D printer. RESULTS: The printed training tool was assembled by fitting the ball-and-socket mechanism between two parts having an overall round table top with integrated vascular clamps. Trial with synthetic and nonliving animal blood vessels shows the utility of the clamps in holding the vessels within the working space. By rotating the top part, a multiaxial vessel orientation from 0 to 360 degrees was achieved. The top part was also capable of multiangular orientation of the vessels (±30 degrees) regardless of its axial orientation during vessel anastomosis. For the 3D-printing process, the average printing time was about 3.5 hours with a cost of 1.3$ per material. CONCLUSIONS: The utility of desktop 3D printing represents an affordable modality in microsurgical training. The designed model is capable of providing a trainee with multiaxial and multiangular vessel orientation during the anastomosis process. To our knowledge, the adoption of this technology in the field of microsurgery training has never been investigated before.
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BACKGROUND: Venous couplers have gained widespread acceptance as an effective, safe, and time-efficient alternative for hand-sewn anastomosis in microsurgical reconstruction. The literature on venous couplers use in pediatric free tissue transfer is scant. The purpose of this study is to present our experience with coupler-assisted venous anastomosis in young pediatric free flap reconstruction. METHODS: This is a retrospective single-center review of all children younger than 10 years old who underwent free flap reconstruction over 36-month period. The primary objective was to assess flap survival rate at 30-day postoperative period. The rate of venous thrombosis, flap take back, flap salvage, and the mean coupling time were also assessed. RESULTS: Four girls and 1 boy with a mean age of 7.3 ± 2.7 years (range 4-10 years) underwent 6 free flap transfers for head and neck, upper limb, and lower limb reconstructions. Microvascular anastomotic coupler system was used for 8 out of 9 performed venous anastomoses with a size ranging from 1.5 to 2.5 mm. Primary flap survival rate was 100%. None of the flaps in our series developed venous thrombosis or required flap take back for microvascular compromise (mean follow-up of 14.4 months). The mean coupling time was 7.1 minutes. CONCLUSIONS: In the current study, venous couplers were safe and reliable in free tissue transfer in children younger than 10 years old. Future studies with larger sample size are needed to further examine the safety and efficacy of venous couplers in pediatric microsurgical anastomosis.