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Introduction The majority of burn injuries in the paediatric age group occur in the home environment and are preventable. Water pipe smoking, commonly known as shisha, is an old practice of tobacco smoking dating from the 16th century with the use of hot coals and water in social gatherings at homes or cafes. The increasing use of shisha worldwide in youth raises public health concerns regarding its detrimental health effects and potential for serious thermal injury. Our aim is to identify and classify epidemiological trends of shisha related burns in the paediatric age group across New South Wales and the Australian Capital Territory. Methods A retrospective review from January 2009 – December 2019 at The Children’s Hospital at Westmead Burns Unit. All burn injuries of age less than 16 years that attended or were referred to the unit were included in this study. Results There were 10 patients who presented with a shisha related burn injury. There was an equal distribution of males to females with all burns occurring in the home or a park. The most common types of injury were a full thickness or mid-dermal burns respectively, three of which required split thickness skin grafting. Conclusions Shisha smoking is part of many cultures that has many potential burn hazards to children and family. Educational awareness targeted to shisha users can bring a better understanding about its potential for burn injury in children.

Cyanoacrylate-based adhesives react aggressively with cotton in a highly exothermic manner. These adhesives are widely available, but the dangers of such glues in producing severe burns are still poorly understood, especially in pediatric populations. There are few case reports examining full-thickness burns resulting from nail glues (a cyanoacrylate-based adhesive), which are often stored in bottles lacking robust safety mechanisms. As a result, there is a lack of understanding by both the general populace and medical community of the severe consequences of such glues contacting cotton-based clothing in both adults and children. Here we present a case of full-thickness burns on the dorsal aspect of the foot of a two-year-old male who spilled nail glue on his sock. The resultant reaction rapidly produced three adjacent burns. The wound required consistent management and healed almost completely after 9 weeks. We aim to raise awareness of full-thickness burns resulting from nail glue spills, as well as to draw attention to the need for better warnings and safety features on glue bottles. We also hope to highlight best practices for the treatment of such burns.

Introduction Defects caused after tumor resection should be closed with flaps that match the neighboring cheek's skin. Presentation of case the authors report a patient diagnosed with squamous cell carcinoma and its management. A 50-year-old man patient presented with a painless slow swelling in the left cheek, which had increased in size in the last four months, tobacco smoking, and alcohol intake for 15 years. Clinical examination revealed left cheek swelling without any lymph nodes at the palpation. Discussion Reconstruction of the full-thickness is a real challenge. The deltopectoral flap offers several advantages despite the increasing use of microvascular reconstruction; technically is a simple and reliable flap that is preferred for the reconstruction of large through-and-through defects after resection of oral carcinoma. Preoperative planning of flap and early recognition of issues can avoid postoperative complications. Conclusion This reconstruction technique was demonstrated in large, full-thickness defects involving the cheek., Highlights • Reconstruction of through-and-through defects of the head and neck is a challenge. • The deltopectoral flap is used despite the increasing use of microvascular reconstruction. • Technically is a simple and reliable flap that is preferred for the reconstruction of large defects after resection of oral carcinoma. • The main treatment of surgical management of head and neck tumors is to achieve a satisfactory functional and aesthetic results.

Highlights • Dermatofibrosarcoma rarely presents as an intra-oral lesion. • Surgical excision in the head and neck region has inherent challenges. • Dermatofibrosarcoma is an insidious tumor that requires careful pathologic margin assessments., Introduction Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally invasive soft tissue tumor with a high rate of recurrence after surgical intervention. DFSP primarily occurs on the trunk and proximal extremities, with reported 10–15% occurring in the head and neck region. DFSP presenting within the oral cavity is a rare entity with few descriptions in the literature. Standard of care involves resection, either by Mohs micrographic surgery or wide local excision with careful evaluation of the surgical margins. Due to the invasive nature of this tumor, complete excision in sensitive areas such as the head and neck pose unique challenges. Case presentation We present a case of DFSP presenting from within the oral cavity, along with its management, in a 50-year-old male. In addition, we review the published literature. The patient neglected a 3-month history of a rapidly enlarging mass of the left cheek. A buccal mucosal biopsy revealed the diagnosis of DFSP. The patient underwent wide local excision of the tumor resulting in a full thickness defect which required reconstruction utilizing a radial forearm free flap. The final pathology report demonstrated positive margins that necessitated additional excision. Discussion There are few reported cases of an intraoral presentation of dermatofibrosarcoma. Due to the sensitive location of the tumor, there are challenges associated with obtaining clear margins after resection and ultimately reconstruction. Conclusion This case and literature review highlight the rarity of an oral cavity presentation DFSP, and the associated surgical challenges.

Background: Scald burns in the neonate are rare in literature, especially major full-thickness injuries in newborns. However, burns are the third most common cause of accidental death among children in the United States. We hope that this report can provide us a new insight for guiding the timing of surgical treatment and the choice of the surgical scheme in severe burn neonates. Case presentation: In this case report, we demonstrate a case of a three-hour-old neonate, who suffered from severe scald burn injuries of 14% of the total body surface area (TBSA). Nearly two weeks after conservative treatment, the wounds showed no sign of healing. Escharotomy following skin grafting was done after the stabilization of the neonate. The neonate was discharged 32 days after injury. Conclusions: Through the review of this case report, we suggest we should pay attention to the following points. First, we should always pay attention to the blood supply of the extremities of the patient, and appropriately relax the indications for deep fasciotomy to reduce the disability rate. Secondly, we should pay special attention to the respiratory system of the newborn, especially for those after cesarean delivery. Moreover, the early application of broad-spectrum antibiotics should be conducted. Third, we should choose antibiotics with less hepatorenal toxicity, and adjust the dosage according to the body surface area of the neonate. Finally, skin grafting is an appropriate treatment and should be done as soon as possible. Keywords: Scald burns, Neonate

The Hirschsprung disease characterised by congenital absence of ganglion cells, is confirmed by sero muscluar biopsies of the involved bowel, hence the initial leveling colostomy/ileostomy followed by subsequent definitive pull through procedure. However only the full circumference of the pulled down bowel having ganglion cells in all four quadrants is confirmatory. Histopathological disparity, differences or errors in diagnosis can arise in both sero muscular and full circumference full thickness biopsy samples, challenging the surgeon in further management of the these children; such a rare case has been described here with is its successful surgical management. Bishop koop procedure classically described in meconium ileus can be attempted in such confusing cases before contemplating major surgical intervention.

Despite being one of the most efficacious drugs used in the treatment of basal cell carcinoma (BCC), imiquimod has limited cutaneous permeation. The current work presents the development of polyvinylpyrrolidone-co-vinyl acetate (PVPVA) microneedles loaded with imiquimod for improving intradermal delivery of imiquimod for the treatment of nodular BCC. In vitro permeation studies, using full thickness ex vivo porcine skin were used to evaluate the effectiveness of these imiquimod loaded polymeric microneedles in comparison to the topical application of commercial Aldara™ cream. HPLC analysis demonstrated similar intradermal permeation of imiquimod from Aldara™ cream and imiquimod-loaded microneedles despite the microneedle having a six-fold lower drug loading than the clinical dose of Aldara™ used for BCC management. In addition, ToF-SIMS analysis of skin cross sections demonstrated intradermal localisation of imiquimod following microneedle-based delivery while the Aldara™ treated skin showed the drug localised predominantly within the stratum corneum. ToF-SIMS analysis also demonstrated intradermal co-localisation of the PVPVA polymer, used in fabricating the microneedle, with imiquimod within the microneedle channels in a label-free manner. This study demonstrates that a polymeric microneedle system may be a viable approach to improving the intradermal delivery of imiquimod for the treatment of nodular BCC with lower drug loading.

Heated intraperitoneal chemotherapy (HIPEC) is commonly performed at the time of tumor resection for metastatic intraabdominal tumors. Post operative complications, such as superficial wound infections or bowel leaks are common. They are largely thought to be secondary to poor wound healing due to chemotherapy-associated neutropenia. Scrotal eschars resulting in full-thickness skin necrosis have rarely been reported as a delayed complication after HIPEC. Here, we present the first case report of penile full-thickness skin necrosis after abdominal cytoreduction with HIPEC combined with ventral hernia repair and mesh placement.

Purpose To describe a novel surgical technique for the removal of a live intravitreal nematode. Observations We describe the surgical management of a 35-year-old man with a live intravitreal nematode in his left eye. A 23-gauge pars plana limited core vitrectomy was performed to release the nematode from the surrounding vitreous strands. After creating a peritomy, a 20-gauge full thickness sclerotomy was created with a microvitreoretinal blade. The tip of a 20-gauge angiocath needle was cut obliquely and inserted through the sclerotomy. The external portion of the needle was attached to the viscous fluid extraction tubing for the Constellation vitrectomy machine (Alcon). Gentle aspiration pulled the nematode into the angiocath. The nematode was transferred to a syringe for parasitologic evaluation. Conclusions and Importance The novel surgical technique described allows for aspiration of an intravitreal nematode in a controlled fashion. This technique can be used to manage this rare, but visually significant condition.

Purpose To describe late-onset fungal keratitis after Descemet's stripping endothelial keratoplasty (DSEK) with positive fungal culture of the donor corneal rim. Observations A case report of a patient undergoing DSEK is described whereby the donor corneal rim culture grew fungus. No infection was initially noted, but the patient developed fungal keratitis 1 year after the original DSEK procedure, despite prophylactic treatment at the time of the positive donor culture. The patient responded to antifungal therapy, but fungal keratitis recurred following completion of a 1-year course of antifungal treatment. The patient eventually underwent full thickness keratoplasty. Conclusions and importance A positive fungal culture of the donor rim tissue at the time of endothelial keratoplasty is a risk factor for fungal keratitis. Even with prophylactic antifungal treatment, fungal keratitis may eventually develop as late as 1 year after the initial endothelial keratoplasty procedure. Treatment may need to be aggressive, but keratitis may recur despite resolution with antifungal treatment.

In this study efficiency of platelet rich plasma (PRP) and zinc oxide on full thickness wounds created on rabbits was researched. This study conducted on 24 New Zealand rabbits divided 2 groups. A circular of 1.5 × 1.5 cm (2.5 cm2) full thickness skin wound was created under the general anesthesia. 1 ml PRP (5.503106/mm3) was applied to the one of the wounds subcutaneously. To the other wound 1 mm3 zinc oxide ointment was applied once a day during the study. Wound contraction rates were measured, biopsy materials were collected and evaluated macroscopically and histopathologically postoperatively 3rd, 7th and 15th days. As a result it is determined that PRP and zinc oxide accelerated wound contraction rates between the groups were determined as 3rd day p = 0.007, 7th day p = 0.0002 and 15th day p = 0.002., Highlights • Wound healing is inborn to all species and is the biologic procedure by which the body repairs itself after injury, whichever it be traumatic, complicated, infected and/or surgical. • Platelet rich plasma (PRP) gel is measured to be progressive wound treatment for acute and chronic wounds. PRP gel has mainly been applied to improve or accelerate healing of wound. • Zinc is a vital trace element in the human body and its significance in wellbeing and infection is valued. Zinc deficiency of genetic or dietary cause can prompt neurotic, pathologic and physiological changes and deferred wound healing. • Topical treatment with autologous PRP can be used as clinical therapy and can enhance tissue healing and enhanced angiogenesis compared to zinc oxide treatments.

Intestinal hypoganglionosis or isolated hypoganglionosis is a rare entity with a clinical and radiologic presentation that can mimic Hirschsprung's disease in the neonatal period. The diagnosis of this entity can be challenging with suction rectal biopsies that are standard for diagnosing Hirschsprung's disease. We present this case of congenital intestinal hypoganglionosis detailing the neonatal course, due to its rarity and the conundrums faced before an eventual diagnosis could be rendered. This case also illustrates the role of full thickness rectal biopsy in selected cases such as ours where the radiologic features are typical of Hirschsprung's, despite negative suction biopsies. Keywords: Intestinal hypoganglionosis, Hirschsprung's disease, Enteric neuropathy

No abstract available Keywords: MMS, Mohs micrographic surgeries; Mohs micrographic surgery; dHACM, dehydrated human amnion/chorion membrane; dehydrated human amnion/chorion membrane allograft; nonmelanoma skin cancer; wound care.

Purpose To present a report of longitudinal changes in radial peripapillary capillaries (RPC) and changes in retinal full thickness (RFT) and peripapillary retinal nerve fiber layer (RNFL) in a patient with Leber hereditary optic neuropathy (LHON). Observations A 42-year-old man presented with acute- and presymptomatic-stage LHON in the left (OS) and right (OD) eyes, respectively, at the initial visit. Onset of LHON in the OD was observed 2 months after the initial visit. Once the temporal RNFL started to decrease in thickness, the areas of temporal RPC defects and RFT thinning gradually increased, indicating that these factors might be correlated. Conclusions and importance Optical coherence tomography angiography showed LHON from the presymptomatic stage. The results indicate that temporal RPC defects and RFT thinning start to spread once the pseudoedema begins to resolve.

Two cases are presented where large (25 mm and 45 mm diameter) skin cancers were removed followed by the application of full thickness skin grafts over the defect where the margins of these defects had been de-epithelialized in order to enhance the take of the full thickness skin grafts.FTSGs have a greater risk of failure as compared to split skin grafts (SSG). This relates to the thickness of the graft (split vs full thickness) and the time to vascularization of the defect bed (48 hours). It is proposed that de-epithelialization of the wound (recipient) margin provides an immediate partial wound vascular bed, reducing the need for adequate vascularization of the recipient wound bed.These cases suggest that with marginal de-epithelialization of the recipient wound margin, survival of a large skin graft can be enhanced. Keywords: Skin neoplasms, Transplantation, Scalp, Hand

Innervated full thickness graft will be presented as an option to reconstruct a fingertip defect which might result in better sensibility than standard reconstruction using a full thickness graft without innervation. Also, anastomosing the nerve stumps can decrease the chance of developing neuroma.

Bony defects of the frontocranial skeleton are commonly the result of traumatic, ballistic, neoplastic etiologies. The three-dimensional structure of this region can sometimes make satisfactory reconstruction a complicated task. A number of alloplastic implant materials have been, and still are, used in the search for a simple and reliable solution to this problem. While surgeons may experience short-term successes with titanium mesh or polyetheretherketone (PEEK), long-term results with regard to implant exposure and infection may vary. In the authors’ experience there is no adequate substitute for the use of autogenous bone graft – split calvarium, split rib, or iliac crest – in reconstructing full-thickness cranial defects. With adequate training there are minimal donor site complications, and there is rarely, if ever, long-term failure of the grafts.

Cardiovascular disease (CVD) is the leading cause of death globally, accounting for 31.5% of deaths worldwide. The widespread (and growing) prevalence of CVD and the inadequacy of the adult human heart to regenerate on its own after a major ischemic event calls for the development of tissue regeneration strategies to facilitate and support cardiomyocyte maturation and function in vivo. This chapter explores regenerative therapies of graded levels of complexity beginning with cell transplantation and ending with a full thickness graft with perfusable vasculature.

Arthroscopic rotator cuff repair is typically performed for small and medium-sized rotator cuff tears. Advancements in technology, instrumentation, and techniques have resulted in good outcomes.

The authority of the early church dominated the period from the late Roman Empire to the Renaissance. The teachings of Galen with their determinism emphasizing the creator’s work was perfect in all aspects were popular with the church. Research was not encouraged. Even so small elements of information were noted. Medical learning passed to Arabic world and to Iran and then returned to Europe. The Italian schools of first Salerno and afterwards Bologna were at the forefront of progress. Dissection finally became legal in Bologna in 1405. It was shown patients could survive traumatic loss of brain substance. Moreover, it was documented that injury on one side could lead to contralateral paralysis. Finally, it was shown that a Valsalva could give a clue as to whether a cranial fissure was full thickness or not. All of this knowledge would be subsequently forgotten.

Current use of juvenile chondral allograft (DeNovo; Zimmer, Warsaw, IN) within the knee is an emerging treatment option for full-thickness, isolated chondral lesions. Its implantation traditionally involves a formal arthrotomy for exposure. Arthroscopic implantation minimizes the morbidity associated with this treatment option yet retains the promising functional results already established in the literature. We present a technique for all-arthroscopic implantation of juvenile chondral allograft (DeNovo) for a symptomatic, isolated chondral lesion within the trochlea of an adult knee.

Highlights • This case-report illustrates that the reconstruction of a degloved foot sole with split-thickness skin grafts can be possible, it s not an ideal situation, because it takes lots of time to heal and to recover for full weight bearing, but the alternative is a transtibial amputation. Which is worse? Its possible, but depends on the patient patience and yours., Introduction The current opinion is that split thickness skin grafts are not suitable to reconstruct a degloved foot sole. The tissue is too fragile to carry full bodyweight; and therefore, stress lesions frequently occur. The treatment of choice is the reuse of the avulsed skin whenever possible, or else the use of a full thickness fascio-cutaneus flap. Presentation of the case A young male sustained a crush injury to his right foot with deglovement of the plantar surface and part of the dorsum. Discussion Split thickness skin grafts are not suitable for full weight bearing, but in special circumstances, certain patients, a lot of time and patience, early mobilization and gradual increasing partial weight bearing it is worthwhile to try. To toughen the foot sole pressure distribution is necessary and can be reached in several ways, soft and springy materials of the inlay, but also socks, orthopedic shoes, casting, orthotics or walking aids. Conclusion This case-report illustrates that the reconstruction of a degloved foot sole with split-thickness skin grafts can be successful; a silicon inner sole was used to prevent stress lesions.

An electrical applicator was designed, which can pierce short microneedles into the skin with a predefined velocity. Three different shapes of microneedles were used, namely 300 µm assembled hollow metal microneedle arrays, 300 µm solid metal microneedle arrays and 245 µm hollow silicon microneedle arrays. The latter are available as 4 × 4, 6 × 6 and 9 × 9 arrays. When using a velocity of 1 or 3 m/s reproducible piercing of dermatomed and full thickness human skin was evident from the appearance of blue spots on the dermal side of the skin after Trypan Blue treatment and the presence of fluorescently labeled particles in dermatomed skin. Manual piercing did not result in the appearance of blue spots. Transport studies revealed that i) piercing of microneedles with a predefined velocity into human skin resulted in a drastic enhancement of the Cascade Blue (CB, Mw 538) transport, ii) A higher piercing velocity resulted in a higher CB transport rate, iii) The CB transport rate was also dependent on the shape of the microneedles and iv) no difference in transport rate was observed between 4 × 4, 6 × 6 and 9 × 9 hollow silicon microneedle arrays. © 2008 Elsevier B.V. All rights reserved.

Highlights - Paediatric burn blister fluid proteome - Over 800 proteins were identified including unique proteins in superficial, deep, and full thickness burns - GO analysis reveal the underlying biological processes respond to burn injury - Increased knowledge of burn blister fluid biochemistry provides valuable insight for clinical practice of paediatric burns Abstract Burn injury is highly traumatic for paediatric patients, with the severity of the burn often dictating the extent of scar formation. The diagnosis of burn wound severity is largely determined by the attending clinician's experience. Thus, a greater understanding of the biochemistry at burn wound site environment and the biology of burns of different severities at an earlier stage may reduce the reliance on subjective diagnoses. In this study, blister fluid was collected from superficial thickness, deep-partial thickness, and full-thickness paediatric burn wounds. Samples were combined together based on burn depth classification and then subjected to four different fractionation methods followed by trypsin digestion. Peptides were analysed by liquid chromatography tandem mass spectrometry in order to measure the proteomeof each fraction. In total, 811 individual proteinswere identified, including 107, 84, and 146 proteins unique to superficial, deep-partial thickness and full-thickness burn wounds, respectively. The differences in the protein inventory and the associated gene ontologies represented within each burn depth category demonstrated that there are subtle, yet significant, variations in the biochemistry of burn wounds according to severity. Importantly, this study has produced the most comprehensive catalogue of proteins from the paediatric burn wound microenvironment to date. Significance: To our knowledge, this study has been the first to comprehensivelymeasure the paediatric burn blister fluid proteome and has provided insight into the proteomic response to burn injury. The study contributes to the knowledge of blister fluid biochemistry of burn injury and provides clinically relevant knowledge through the qualitative evaluation of biochemical differences between burns of different depths. A better understanding of the burn wound environment will ultimately assist with more accurate clinical decision making and improved wound healing and scar reduction procedures.

Tears in the gluteus medius and minimus tendons recently have emerged as an important cause of chronic greater trochanteric pain syndrome. Increasing recognition of the gluteal insertion as a cause of chronic pain and weakness, as well as technologic advances in endoscopic hip surgery, has made gluteal insertional repair a rapidly emerging technique in minimally invasive surgery of the hip. We present an endoscopic double-row technique for gluteal insertional repair that allows for visualization, debridement, and repair, re-creating the normal footprint.

Resume L'arthroscopie d'epaule est un moyen fiable et valide de reparation de la coiffe des rotateurs. Elle est moins traumatisante pour le patient et permet une analyse plus fine de la rupture et des lesions associees. C'est une technique exigeante dont la courbe d'apprentissage particulierement longue et difficile necessite rigueur et perseverance. Elle demande une attention particuliere a tous les details en commencant par l'installation, le mode d'anesthesie et le choix d'une instrumentation et d'un materiel adaptes. Une bonne visualisation est essentielle, elle repose sur la precision des voies d'abord et la qualite du debridement et permet une analyse lesionnelle complete afin de planifier le geste de reparation en fonction de la localisation, de la forme et de l'importance de la lesion. Une fixation solide, en une ou deux rangees, repose sur le bon positionnement des ancres, un passage tendineux peu traumatisant et surtout une liberation optimale afin de reduire la tension sur les points d'ancrage. Les ruptures tres retractees pourront necessiter des gestes d'arthrolyse complementaires et des techniques de reparation plus complexes associant des sutures en convergence des berges tendineuses a la reinsertion osseuse. Depuis une vingtaine d'annees, l'evolution du materiel, la codification et la simplification de la technique operatoire en ont fait une chirurgie accessible et reproductible, dont les resultats ont ete evalues et valides.

Introduction The healing of grafted areas after surgical treatment of deep burns frequently generates mutilating scars, and rises the risk of subsequent scar hypertrophy. Scar assessment based on clinical evaluation is inherently subjective, which stimulates search for objective means of evaluation. Objective The aim of this study was to objectively evaluate the effect of using autologous platelet concentrate (APC) in combination with split thickness skin grafting (STSG) on scarring processes following surgery of deep burns as compared with application of STSG alone. Method Selected viscoelastic properties of 38 scars on 23 patients in total were examined using the Cutometer MPA 580 under controlled conditions for long-term outcomes 1, 3, 6 and 12 months after surgery following deep burns. Results The findings of this study suggest that the STSG + APC combination reduces the time of scar viscoelastic properties recovery as compared with application of STSG alone. This was statistically significant for viscoelastic parameters R2 and Q1. Conclusion APC has been advocated to enhance scarring after surgery of deep dermal and full thickness burns. We objectively demonstrated that the viscoelastic properties of scars treated with STSG + APC combination return more rapidly to the plateau state than areas treated with STSG only. Web of Science 39 6 1276 1263

This chapter is a summary of three interdigitated investigations to identify the neural substrate underlying supranormal vision in the congenitally deaf. In the first study, we tested both congenitally deaf and hearing cats on a battery of visual psychophysical tasks to identify those visual functions that are enhanced in the congenitally deaf. From this investigation, we found that congenitally deaf, compared to hearing, cats have superior visual localization in the peripheral field and lower visual movement detection thresholds. In the second study, we examined the role of "deaf" auditory cortex in mediating the supranormal visual abilities by reversibly deactivating specific cortical loci with cooling. We identified that in deaf cats, reversible deactivation of a region of cortex typically identified as the posterior auditory field (PAF) in hearing cats selectively eliminated superior visual localization abilities. It was also found that deactivation of the dorsal zone (DZ) of "auditory" cortex eliminated the superior visual motion detection abilities of deaf cats. In the third study, graded cooling was applied to deaf PAF and deaf DZ to examine the laminar contributions to the superior visual abilities of the deaf. Graded cooling of deaf PAF revealed that deactivation of the superficial layers alone does not cause significant visual localization deficits. Profound deficits were identified only when cooling extended through all six layers of deaf PAF. In contrast, graded cooling of deaf DZ showed that deactivation of only the superficial layers was required to elicit increased visual motion detection thresholds. Collectively, these three studies show that the superficial layers of deaf DZ mediate the enhanced visual motion detection of the deaf, while the full thickness of deaf PAF must be deactivated in order to eliminate the superior visual localization abilities of the congenitally deaf. Taken together, this combination of experimental approaches has demonstrated a causal link between the crossmodal reorganization of auditory cortex and enhanced visual abilities of the deaf, as well as identified the cortical regions responsible for adaptive supranormal vision.

Open rotator cuff repair is best addressed by a well-established, systematic sequence of steps including exposure, tear assessment, and tendon mobilization and repair. Augmentation by the application of a collagen patch may enhance a repair.

Macular holes (MHLs) first described over a century ago by Noyes [1], have seen a renewed interest in their pathophysiology and management in the last two decades. They occur following trauma, laser treatment, cystoid macular edema, retinal vascular disorders, retinal detachment (RD) or may not have any detectable cause. Most MHLs occur as age-related primary idiopathic entities. Full thickness MHLs were once considered untreatable and were treated only when there was an accompanying extensive RD. Initially MHLs were treated with achieving strong vitreo-retinal (VR) adhesions around the MHL but with refinement of VR techniques and emphasis on tangential traction being responsible for the MHL, retinal surgeons are attempting treatment with vitrectomy, membrane peeling and intra-ocular gas tamponade.

The successful repair of articular cartilage must rely on the restoration of the full thickness of the layer with full structural integration laterally with the existing material on the joint surface. The knee is the most commonly affected joint for cartilage degeneration and it is this joint that will be used as the basis for our investigations. Previously, textile mesh structures (based on intermeshed yarns) have been designed and used to provide an oriented repair of biological tissue in the body e.g. the repair of hernia in men. The repair of articular cartilage defects in lesions of the knee has also been described using a nonwoven structure with random fibre orientation into which repair tissue grows to provide a load-bearing surface. It is proposed that shape data (using the selection criteria of cartilage thickness 1 mm and associated underlying bony changes) is generated in 3D space by imaging methods, and used together with structural information from the current knowledge base arising from previous studies and published material. This will allow a computer model of the architecture to be constructed. The “male’ form of the shape data will be used to design and manufacture textile engineered implants. It is envisaged that the ‘female’ shape around the lesion could be used as a surgical positioning tool to cut out (If necessary) the desired shape of the lesion to seat the final implant material. It is anticipated that a textile implant of pre-defined structure will be in a rigid or semi-rigid form, with the ‘zonal’ information relating to the structural architecture of the lesion built-in. In any generic class of textile material, including nonwovens, there is no single form of 3D structural architecture and this can be manipulated during manufacture. This has been overlooked in other studies using textile scaffolds. The fibre orientation, the porosity and the physical properties of the structure may be adjusted within wide limits. Different generic textile structures containing yarns, mechanically entangled fibres, films and membranes can also be combined depending on the required functionality of the material. Using the shape and thickness data obtained from imaging, it is proposed to design and evaluate textile structures of selected physical and mechanical properties that would reproduce a repair of similar structural design to the original articular cartilage at that site.

Blast trauma due to fragmentation devices can be devastating. The management of complex and multiple injuries, particularly when associated with intra-abdominal injuries and complicated by abdominal wall defect is a test of endurance for both patient and the surgeon. The reconstructive goals for the abdominal wall defect in such cases are to preserve life by providing a speedy cover to exposed abdominal viscera, protect the abdominal contents and provide functional support. Full thickness abdominal wall defects exceeding 6 cm in transverse diameter have been categorized as massive [1]. Their closure requires import of autogenous tissue in the form of vascularised flaps. Reconstruction by local or regional flaps may not be feasible in the acute stage on account of involvement of donor areas and the resultant defect at the donor site. We report a case of staged reconstruction of a massive abdominal wall defect following blast trauma from a land mine explosion by tissue expansion and prosthetic mesh.

Some of the methods used for counting objects in histological sections are discussed. The method best suited for any particular counting program depends on many variables, which include the level of accuracy required, the type of preparation available for study, the size of the objects to be counted, the thickness of the sections that can be used, the equipment available and the amount of labor that can reasonably be invested. For light and electron microscopy, profile counts are simple and quick for objects that are small relative to section thickness and whose dimensions are readily defined. The 'physical disector' is particularly useful where objects to be counted are large relative to sections thickness, or where their dimensions are unknown or highly variable. For light microscopy, the optical disector is often easier to use. However, it makes more assumptions than the physical disector; some of these can introduce serious bias in the counts, and they are explored. Electron microscopy raises some special problems that relate to the depth of focus, the relatively very thin sections, and the tendency for thin structures that do not span the full thickness of a section to be lost or unrecognizable in some section planes. The importance of recognizing the assumptions that underlie any method of counting and its interpretation is stressed.