Search

Aims It is estimated that approximately 15% of adults over 60 years old suffer from a mental disorder. Self-harm and suicidal ideation are associated with a range of mental disorders, and high rates of suicide. The aim of this project is to identify the characteristics of older people who present with self-harm and suicidal ideation to an emergency department (ED) in a university hospital. In examining the variables associated with self-harm we may be better able to identify the characteristics of older adults who are at highest risk. Methods We conducted a cohort study of older adults (aged 65 years+) who presented to the Mater Misericordiae University Hospital with a mental health problem from 2008–2022 (a 15-year cohort). Data were extracted from the Electronic Patient Records including all patients who presented to the ED in that time period with a mental health triage code. We examined this cohort to collect detailed information on the characteristics of those older people presenting with self-harm and suicidal ideation. Results We identified 30,941 ED attendances with a mental health triage code between 2008 and 2022. Of these, 946 (3.1%) were older adults. One-fifth (20%) presented with self-harm, a further 21% reported suicidal ideation. Of these, 8% reported previous self-harm and 32% had previously been reviewed by psychiatry. Over one-third (38%) were admitted. Of those, the majority (78%) were admitted to a medical or surgical ward, 16% to a psychiatric ward and 5% to critical care. Of those presenting with self-harm 37% were admitted to hospital – 32% to a medical or other ward and 5% to psychiatric unit. There was a significant difference in those who were admitted with self-harm versus suicidal ideation (p < 0.001). Conclusion Our results demonstrate key insights into older adults who presented to the ED with self-harm and suicidal ideation. These patients were more likely to be admitted to a medical ward than a psychiatric unit, and those with self-harm were more likely to be admitted medically compared with those with suicidal ideation. Possible reasons for these results include the higher rate of medical co-morbidity in older adults and the potential high lethality of self-harm in this cohort. Another explanation could be the scarcity of acute psychiatric beds necessitating medical admission. There is a need for further exploration of this high-risk population.

Background: Bone defects after trauma, infection, or tumour resection present a challenge for patients and clinicians. To date, autologous bone graft (ABG) is the gold standard for bone regeneration. To address the limitations of ABG such as limited harvest volume as well as overly fast remodelling and resorption, a new treatment strategy of scaffold-guided bone regeneration (SGBR) was developed. In a well-characterized sheep model of large to extra-large tibial segmental defects, three-dimensional (3D) printed composite scaffolds have shown clinically relevant biocompatibility and osteoconductive capacity in SGBR strategies. Here, we report four challenging clinical cases with large complex posttraumatic long bone defects using patient-specific SGBR as a successful treatment. Methods: After giving informed consent computed tomography (CT) images were used to design patient-specific biodegradable medical-grade polycaprolactone-tricalcium phosphate (mPCL-TCP, 80:20 ​wt%) scaffolds. The CT scans were segmented using Materialise Mimics to produce a defect model and the scaffold parts were designed with Autodesk Meshmixer. Scaffold prototypes were 3D-printed to validate robust clinical handling and bone defect fit. The final scaffold design was additively manufactured under Food and Drug Administration (FDA) guidelines for patient-specific and custom-made implants by Osteopore International Pte Ltd. Results: Four patients (age: 23–42 years) with posttraumatic lower extremity large long bone defects (case 1: 4 ​cm distal femur, case 2: 10 ​cm tibia shaft, case 3: complex malunion femur, case 4: irregularly shaped defect distal tibia) are presented. After giving informed consent, the patients were treated surgically by implanting a custom-made mPCL-TCP scaffold loaded with ABG (case 2: additional application of recombinant human bone morphogenetic protein-2) harvested with the Reamer-Irrigator-Aspirator system (RIA, Synthes®). In all cases, the scaffolds matched the actual anatomical defect well and no perioperative adverse events were observed. Cases 1, 3 and 4 showed evidence of bony ingrowth into the large honeycomb pores (pores >2 ​mm) and fully interconnected scaffold architecture with indicative osseous bridges at the bony ends on the last radiographic follow-up (8–9 months after implantation). Comprehensive bone regeneration and full weight bearing were achieved in case 2 ​at follow-up 23 months after implantation. Conclusion: This study shows the bench to bedside translation of guided bone regeneration principles into scaffold-based bone tissue engineering. The scaffold design in SGBR should have a tissue-specific morphological signature which stimulates and directs the stages from the initial host response towards the full regeneration. Thereby, the scaffolds provide a physical niche with morphology and biomaterial properties that allow cell migration, proliferation, and formation of vascularized tissue in the first one to two months, followed by functional bone formation and the capacity for physiological bone remodelling. Great design flexibility of composite scaffolds to support the one to three-year bone regeneration was observed in four patients with complex long bone defects. The translational potential of this article: This study reports on the clinical efficacy of SGBR in the treatment of long bone defects. Moreover, it presents a comprehensive narrative of the rationale of this technology, highlighting its potential for bone regeneration treatment regimens in patients with any type of large and complex osseous defects.

Background and Aims: The advent of 3D printing has revolutionized plastic surgery and prosthetic devices, providing personalized solutions for patients with traumatic injuries, deformities, and appearance‐related conditions. This review offers a comprehensive overview of 3D printing's applications, advantages, limitations, and future prospects in these fields. Methods: A literature search was conducted in PubMed, Google Scholar, and Scopus for studies on 3D printing in plastic surgery. Results: 3D printing has significantly contributed to personalized medical interventions, with benefits like enhanced design flexibility, reduced production time, and improved patient outcomes. Using computer‐aided design (CAD) software, precise models tailored to a patient's anatomy can be created, ensuring better fit, functionality, and comfort. 3D printing allows for intricate geometries, leading to improved aesthetic outcomes and patient‐specific prosthetic limbs and orthoses. The historical development of 3D printing, key milestones, and breakthroughs are highlighted. Recent progress in bioprinting and tissue engineering shows promising applications in regenerative medicine and transplantation. The integration of AI and automation with 3D printing enhances surgical planning and outcomes. Emerging trends in patient‐specific treatment planning and precision medicine are potential game‐changers. However, challenges like technical considerations, economic implications, and ethical issues exist. Addressing these challenges and advancing research in materials, design processes, and long‐term outcomes are crucial for widespread adoption. Conclusion: The review underscores the increasing adoption of 3D printing in healthcare and its impact on plastic surgery and prosthetic devices. It emphasizes the importance of evaluating the current state and addressing knowledge gaps through future research to foster further advancements [ABSTRACT FROM AUTHOR]