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Soft tissue injuries are common in the military, generally producing simple hematomas without the need for intensive evaluation and management. In certain situations, a shearing effect between fascial planes whereby a disruption of the vasculature and lymphatic systems creates a "closed degloving injury" is more generally referred to as a Morel-Lavallée Lesion (MLL). With a consistent pool of blood, lymph, and pieces of soft tissue, an M7LL can cause significant poor cosmesis, chronic pain, and risk secondary infection if left undetected and untreated. Proper diagnosis can be made through the effective use of ultrasound and, if detected early enough, through conservative measures to include needle aspiration and compression sleeves. Prior cases describe chronic MLLs existing for extended periods of time, in some cases years, requiring operative intervention, and in some cases poor outcomes. We present two cases of active duty soldiers presenting with seemingly innocuous injuries found on closer evaluation to have MLL, treated in one case with needle aspiration and compression, in the other with operative management. [ABSTRACT FROM AUTHOR]

Objective: Increasing aesthetic demands require that the color and contour of the peri‐implant soft tissues be in harmony with the neighboring teeth. Recession, migration toward the apical, is a frequent clinical finding. Its presence can lead to inflammation and increased marginal bone loss. These complications, in addition to affecting the aesthetic results of our treatment, are difficult to treat and can threaten the survival of the implant. There are fewer studies showing the outcome of treatment of soft‐tissue defects around implants. The aim of this article is to describe the treatment of a soft‐tissue defect around an implant‐supported prosthesis treatment, performed on two neighboring implants, in the esthetic zone in a patient with a high smile and to evaluate both the coverage achieved and the patient's esthetic satisfaction. Clinical Considerations: This study showed that a mucogingival approach, using a surgical technique designed for the treatment of alveolar ridge defects, together with tissue management with temporaries and a new restoration, achieved an optimal result. Conclusions: The case has been closely followed up, for 10 years, and the authors have been able to confirm the long‐term stability of the result. Clinical Significance: The following paper shows the result of an innovative approach. Connective tissue platform technique, usually performed for soft‐tissue augmentation, was used for a defect in soft‐tissue dehiscence. The authors followed the results for 10 years, and the results achieved were satisfactory in terms of esthetic. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aimed to characterize and evaluate the emergency approach, diagnosis, management, treatment, and follow‐up of nonspecific canine lameness cases. Design: Retrospective case series from September 25, 2013 to September 25, 2014. Setting: The study was conducted at an urban university teaching hospital. Animals: A consecutive sample of dogs presenting to the emergency service with nonspecific lameness in the designated timeframe was used to identify 134 cases. Owners were contacted to participate in the follow‐up survey; dogs that died prior to data collection were excluded from the survey. Medical records were reviewed for lameness localization, etiology of lameness, diagnostics obtained, medications prescribed, and owner recommendations. Interventions: Based on review of the medical records, the lameness localization, presumptive source of lameness (joint, soft tissue, neurological, or bone), diagnostics obtained, medications prescribed, and owner recommendations were recorded. Survey data included duration of lameness, perceived response to treatment, and activity level. Measurements and Main Results: Definitive diagnoses were not assigned in 88.8% of lameness cases. A presumptive diagnosis of soft tissue injury was assigned in 45.3% of cases. Single limb lameness was more prevalent than multiple limb lameness. Owners whose dogs were treated with medication were significantly more likely to report that the lameness resolved (P = 0.049). Dogs with injury localized to ≥1 of the joints were significantly less likely to have resolution of lameness (P = 0.037). Treatment recommendations were predominantly pain control and activity restriction. Conclusions: Nonspecific lameness represents approximately 4% of canine urban emergency cases. Highlighting the points of clinical care considerations in understanding the etiology of lameness in dogs represents an opportunity for improved patient care and growth in emergency referral and follow‐up. [ABSTRACT FROM AUTHOR]

For acute and chronic soft tissue infections, radical surgical debridement is required and is considered the gold standard, along with its immediate systemic antibiotic therapy. Treatment with local antibiotics and/or antibiotic-containing materials is commonly used as an additional tool in clinical practice. Spraying with fibrin and antibiotics is a newer technique that has been studied for some antibiotics. However, for gentamicin, data are not yet available on absorption, optimal application, antibiotic fate at the site and transfer of antibiotic into the blood. In an animal study involving 29 Sprague Dawley rats, 116 back wounds were sprayed with gentamicin using either gentamicin alone or one of two possible spray combinations of gentamicin and fibrin. Simultaneous application of gentamicin and fibrin via a spray system to soft tissue wounds resulted in significant antibiotic concentration over a long period of time. The technique is easy and cost-effective. The systemic crossover was significantly minimized in our study, which may have led to fewer side effects in patients. These results could lead to an improvement in local antibiotic therapy. [ABSTRACT FROM AUTHOR]

Background: Meniscal allograft transplant (MAT) is an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy. However, the literature contains a paucity of studies assessing the survival rate and prognostic factors of soft tissue MAT. Purpose: To report the survivorship of a large, single-center cohort of consecutive patients treated with arthroscopic MAT using soft tissue technique and to investigate variables that could potentially influence failures and outcomes. Study design: Case series; Level of evidence, 4. Methods: Consecutive MAT procedures totaling 364 performed in a single institution between June 2004 and April 2019 were screened and assessed for eligibility. Subjective clinical scores (Lysholm score, Tegner activity scale, and visual analog score) were collected preoperatively and at 2, 5, 7, and 10 years of follow-up. Two survival analyses were performed using Kaplan-Meier curves, with surgical failure (defined as any graft revision) and clinical failure (defined as a Lysholm score <65 points) used as endpoints. Univariate analyses were performed using reoperations, surgical failure, clinical failure, and different demographic and surgical characteristics as endpoints. Results: A total of 324 consecutive patients were evaluated at a mean follow-up 5.7 ± 3.0 years. Of these, 189 (58%) underwent an associated surgical procedure. A total of 22 patients (6.8%) were considered to have experienced surgical failure, and no predictors of surgical failure were identified based on the relevant variables. When all patients were considered, a significant improvement in all of the patient-reported outcome measures was present between the preoperative assessment and the last follow-up (P <.001), with no significant decrease over time. Moreover, 70 (21.6%) patients were considered to have experienced clinical failure; the need for concurrent cartilage procedures (odds ratio, 0.16; P =.001) and anterior cruciate ligament (ACL) reconstruction (odds ratio, 0.40; P =.059) were predictors of failure. Finally, a lower survival rate was reported in female patients compared with male patients (49% vs 69%, respectively; P =.007) and in patients who required cartilage surgery (P =.014). In particular, patients who required cartilage surgery showed nearly half the survival rate compared with those with required no cartilage procedures at 10-year follow-up (36.4% vs 71%, respectively; P =.029). Conclusion: Female sex and the need to combine MAT with a cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at midterm follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Intrathecal baclofen (ITB) is a well-known treatment option for cerebral palsy (CP) spasticity. The combination of soft-tissue release and ITB for spasticity is common. This study compared patients who had soft-tissue release before ITB (PRE-ITB), soft-tissue release at the same time as ITB (ST-ITB), and no ITB (NON-ITB) but had soft-tissue release at a similar age as PRE-ITB. Methods: Inclusion criteria were a spastic or mixed nonambulatory CP diagnosis, prior hip adductor surgery, no prior reconstructive surgery, and at least a five-year post-operative follow-up. Thirty hips were identified as PRE-ITB, 20 hips as ST-ITB, and 43 hips as NON-ITB. The primary outcome variables were the subsequent hip surgery during the study period and/or a migration percentage ≥ 50% at the final follow-up defined as "unsuccessful hip." Results: The mean follow-up duration was 9.0 years (SD 2.4) for PRE-ITB, 9.4 (SD 3.6) for ST-ITB, and 9.3 (SD 3) for NON-ITB. The odds of unsuccessful outcomes were not different between NON-ITB and PRE-ITB but were lower for the ST-ITB group. The need for subsequent osteotomies or revision adductor surgery was significantly higher in ST-ITB compared with PRE-ITB (p = 0.02) or NON-ITB (p = 0.015). The incidence of surgical site infection over the whole follow-up period was higher in ST-ITB (40%) compared with PRE-ITB (13.3%, p = 0.035) and NON-ITB (0, p < 0.001). Conclusion: The addition of tone management with ITB did not reduce the need for later hip surgery but did increase the risk for surgical site infection. [ABSTRACT FROM AUTHOR]

Background: Most authors cite that an ingrown toenail is caused by an ingress of the nail plate into the periungual soft tissues, though a minority of authors believe that soft tissue pathology is primarily responsible. Consequently, when nail surgery is indicated, there is a dichotomy in the treatment approach aimed at either nail/nail matrix resection or soft tissue debridement. Aim: The aim of this research is to collate, code and chart data regarding ingrown toenails managed with soft tissue procedures - without nail or nail matrix resection. Methods: A scoping review of the literature on soft tissue resection techniques for the management of ingrown toenails without nail or nail matrix resection was carried out using current scoping review practice and PRISMA-ScR guidelines. Results: 25 articles were included in the review. Most of these papers were case studies or case series. Multiple surgical techniques were found but with no clear best technique identified due to low-quality research using heterogeneous methodologies. Conclusions: The evidence for the soft tissue management of ingrown nails is lacking in quality but warrants further consideration. High quality, perspective studies need to be performed to be eligible for future Cochrane reviews. [ABSTRACT FROM AUTHOR]

Purpose: The reconstruction of defects resulting from spinal surgery poses a challenge to plastic surgeons due to the curved contour and strong skin tension of the back. Implant and metal exposure can also increase the difficulty of covering such defects. This study presents our experiences of covering defects after spinal surgery using dorsal intercostal artery perforator (DICAP) flaps. Methods: From November 2018 to August 2021, 14 patients with spinal soft tissue defects underwent DICAP flap reconstructive surgery at our department. The mean age of the patients was 54.3 years (range, 35--70 years). Age, sex, etiology, the dimensions of the defect and the flap, the site of the defect, surgical technique, and postoperative complications were recorded. Results: All flaps survived, with no major complications such as total flap necrosis. Minor complications were observed in four cases. One patient developed an infection with erythematous changes and another developed partial flap necrosis. Two patients experienced wound dehiscence. These minor complications were all resolved with conservative treatment. No additional complications occurred during the follow-up period. Conclusion: The use of DICAP flaps was successful in all cases. DICAP flaps can adequately cover defects following spinal surgery and have a low complication rate. Thus, DICAP flaps are a good choice for covering defects resulting from spinal surgery. [ABSTRACT FROM AUTHOR]

Background: Maxillofacial soft tissue injuries (STIs) are common and frequent in emergency departments. The aim of this study was to analyze factors causing infection of maxillofacial STIs. Patients and Methods: Patients with maxillofacial STIs who received sutures and had complete medical records were evaluated. Gender, age, American Society of Anesthesiologists (ASA) grade, diabetes mellitus, wound age, wound length, wound contamination, wound type, and sites were analyzed using univariable analysis and binary logistic regression. Results: There were 3,276 cases included. In the univariable analysis, there was no significant difference in the infection rate between genders or between the wound age groups. In binary logistic regression, age, wound length, wound type, and physician level were risk factors for infection: age of 18-44 years (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7-2.9), 44-64 years (OR, 3.1; 95% CI, 2.3-4.3), and ≥65 years (OR, 2.6; 95% CI, 1.7-4.1); wound length of 4-8 cm (OR, 1.7; 95% CI, 1.3-2.2) and >8 cm (OR, 2.4; 95% CI, 1.1-5.1); intra-oral wounds (OR, 1.6; 95% CI, 1.1-2.4) and communicating wounds (OR, 3.2; 95% CI, 2.3-4.4); junior specialists (OR, 1.6; 95% CI, 1.2-2.2); and lip (OR, 3.7; 95% CI, 1.1-12.0) and cheek (OR, 4.7; 95% CI, 2.3-17.1) sites. Wound contamination, ASA grade, and diabetes mellitus were not significantly different from wound infection in binary regression analysis. Conclusions: Age (>18 years old), wound length (>4 cm), intra-oral wounds, communicating wounds, suturing by junior surgeons, and lip or cheek injuries may be risk factors for maxillofacial STI infection. Even if the penetrating wound age exceeds 24 hours, it is meaningful to suture if there is no serious infection. For wounds at high risk of infection, further measures should be considered to reduce the possibility of infection, such as improving the surgical training of junior surgeons and improving the patient's wound care. [ABSTRACT FROM AUTHOR]

Aim: Bone-borne rapid maxillary expander (RME) is one of the latest expander designs being used for skeletal expansion by applying forces through palatal mini-screws. The purpose of this retrospective study was to evaluate soft tissue facial changes following RME using 3D stereophotogrammetry. Materials and Methods: A total of 15 subjects (6 males and 9 females) with a mean age of 12.1±1.4 years who underwent upper arch expansion using bone-borne RME as a component of their orthodontic therapy were recruited in this retrospective study. 3D facial images (3dMD Ltd, Atlanta, Ga) generating 3D soft tissue meshes before expansion (T0), immediately after expansion (T1), and after a 3-month retention phase (T2) were used to capture facial scans of 15 subjects. Based on twenty-three landmarks, 10 linear measurements were made from each of 3D images. Comparisons of measurements at 3 different times were evaluated with one-way Repeated Measures Analysis of Variance (p < 0.05). Results: Statistically significant changes were observed in the mouth (chr-chl) and nasal (alr-all) width in T0-T1 and T0-T2. No significant differences were found in the upper and lower face heights, total face height, upper and lower lip heights, upper and lower vermillion heights and intercanthal width. Conclusion: Significant increases in mouth and nose width were obtained by bone-borne RME. These changes remained stable for 3 months. 3D stereophotogrammetric facial imaging method is an easy and non-invasive method that can be used to analyze the changes of facial soft tissues after RME treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2 years postoperatively. Methods: Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up. Results: The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38 mm. Union was achieved at mean 12.3 weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05 mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis. Conclusions: AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation. Level of evidence: Level IV, Retrospective case series. [ABSTRACT FROM AUTHOR]

The nose is one of the most common sites of facial injury due to its prominence and anatomical placement. Given its intricate anatomy, function, and high visibility, it also proves to be one of the most complex regions for repair. We provide a review of the management of soft tissue injuries to the nose, including the various reconstructive tools available and adjunctive wound care measures. We also discuss special considerations based on mechanism of injury and treatment of this condition in the pediatric population. The main goals of reconstruction should be to preserve function while achieving optimal cosmetic results in this highly visible region of the face. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate (1) the efficacy of varus–valgus stress radiographs to adjust the preoperative soft-tissue imbalance and (2) ascertain whether varus–valgus stress radiographs are effective for the correction accuracy in the preoperative planning of the opening wedge high tibial osteotomy (OWHTO). Methods: From February 2017 to December 2018, a total of 121 consecutive knees that underwent bi-planar OWHTO were enrolled in this retrospective analysis. Preoperative planning was performed using a weight-bearing line (WBL). Target WBL was determined according to the status of the medial compartments such as cartilage, meniscus, and preoperative arthritic grade. Preoperative varus–valgus stress radiographs were used to assess the preoperative mediolateral ligament imbalance. The final target correction length of the opening gap was determined by subtracting the difference between the varus–valgus stress radiographs (VVD). All patients were divided into two groups according to the preoperatively planned correction degree: (group A), smaller than average; (group B), larger than average. Patients were also divided into two other groups (VVD adjusted and neglected groups). Results: Groups A and B were 56 and 54 knees, respectively. The preoperatively planned correction lengths of the opening gap were 9.33 ± 1.5 and 14.16 ± 3.96 mm, respectively (p < 0.01). Mean values of the VVD were 0.85 ± 0.72, and 1.27 ± 1.78 mm, respectively (p < 0.01). Correction errors were 2.17 ± 2.06 and 3.52 ± 2.16%, respectively (p < 0.01). Planned and final correction degrees were also significantly larger (p < 0.01, and p < 0.01, respectively), because the preoperative WBL ratio was significantly smaller in the VVD adjusted group (p < 0.01). Conclusion: The VVD values could reproduce the preoperative soft-tissue imbalance and it was more prominent as the correction degree increased. The strategy of subtracting the VVD as assumed soft-tissue imbalance in the preoperative planning worked well for the correction accuracy during OWHTO. Level of evidence: Level IV, retrospective study. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate peri‐implant tissue dimensions following nonsurgical (NS) and surgical therapy (S) employing different decontamination protocols of advanced ligature‐induced peri‐implantitis in dogs. Material & Methods: Peri‐implantitis defects (n = 5 dogs, n = 30 implants) were randomly and equally allocated in a split‐mouth design to NS or S treatment using either an Er:YAG laser (ERL), an ultrasonic device (VUS), or plastic curettes + local application of metronidazole gel (PCM), respectively. Horizontal bone thickness (hBT) and soft tissue thickness (hMT) were measured at different reference points: (v0) at the marginal portion of the peri‐implant mucosa (PM); (v1) at 50% of the distance from PM to bone crest (BC); (v2) at the BC; (v3) at the most coronal extension of the bone‐to‐implant contact. Vertical peri‐implant tissue height was calculated from PM to BC. Results: All of the treatment groups showed a gradual hMT increase from v0 to the v2 reference point, followed by a reduction from v2 to the v3 region. The S‐VUS subgroup tended to be associated with higher hMT values at the v0 region than the NS‐VUS subgroup (0.44 mm versus 0.31 mm). PM‐BC distance varied from 2.22 to 2.83 mm in the NS group, and from 2.07 to 2.38 in the S group. Conclusion: Vertical and horizontal peri‐implant tissue dimensions were similar in different treatment groups. [ABSTRACT FROM AUTHOR]

The article presents the results of experimental modeling of superficial fragment gunshot wounds of soft tissues, obtained in low-energy gunshot wounds. The pathomorphosis of gunshot wounds was studied, and the features and timing of their healing were compared depending on the temperature of the damaging fragments. The aim of the work was to study the effect of the temperature of the injuring shrapnel on the healing processes of the soft tissues of experimental animals with superficial low-energy fragment gunshot wounds. Using the random number method, laboratory animals (rabbits) were divided into 3 experimental groups (15 animals each). In each group, wounding was with fragments with different temperatures − 18°С, 50°С and 100°С. The control group consisted of 10 intact animals. On day 14th, 30th and 60th, 5 animals from each group were withdrawn from the experiment. Microscopic examination of soft tissues was performed using a PRIMO STAR light microscope (Carl Zeiss, Germany) at magnification by 56 and 400 times. When assessing the state of tissues in the area of wound damage, it was established that as the temperature of the injuring fragment increases, a slower filling of the defect formed by the necrotic detritus in the process of utilization of necrotic detritus is observed. The high temperature of the injuring fragment along with the mechanical rupture of tissues causes thermal coagulation necrosis. Dense coagulated necrotic masses covering the wound canal from the inside, not only increase the volume of necrotic masses, but also complicate the process of wound healing. At a temperature of wounding fragments 100°C, the formation of a necrotic crust on the surface of the wound occurred on average 3±1.2 days later than at temperatures of 18°C and 50°C, the least pronounced healing took place at the bottom of the wound and in the muscle tissue. Microscopically necrotic, not dystrophic changes were observed in myocytes. Thus, a comparative analysis of the pathomorphosis of soft tissues in a wound when injured from an air rifle MP-532 with different temperature of the fragments showed differences from both the alteration of the tissues and the regenerative potential. [ABSTRACT FROM AUTHOR]

Introduction: Reconstruction of chronic lower extremity wounds can be especially challenging when these wounds are complicated by osteomyelitis. They require the joint expertise of plastic and orthopaedic surgeons.Methods: We report our experience using the Keystone Perforator Island Flap following wound and bone debridement as a valuable surgical tool for coverage of complex wounds with bone infection.Results: Twelve patients underwent similar procedures with overall good outcomes, although two patients experienced a complication, specifically partial flap necrosis and wound dehiscence subsequent to recurrent osteomyelitis. We also reviewed the underlying physiological mechanisms of employing the Keystone flap in order to demonstrate its advantages and efficacy.Conclusion: Our results confirm that the Keystone flap can be a safe, reliable and effective method for coverage of soft tissue defects and the preservation of bone integrity in the management of patients with chronic osteomyelitis. [ABSTRACT FROM AUTHOR]

Objectives: To test the non‐inferiority of demineralized bovine bone mineral (DBBM) compared to demineralized bovine bone mineral with 10% collagen (DBBM‐C) for the maintenance of the soft tissue contour after tooth extraction in the esthetic zone. Material and Methods: Sixty‐five patients randomly received ridge preservation at a single site in the anterior maxilla with DBBM or DBBM‐C. Both, DBBM and DBBM‐C, were covered with a collagen matrix. Profilometric analyses were performed at baseline (BL), immediately after treatment (PO), and at 4 months (FU; day of implant placement). The main outcome was the horizontal mean change (HC) at the buccal aspect. The measurements also included changes of the estimated soft tissue thickness (eTT) at 1, 3, and 5 mm below the buccal gingival margin. Descriptive analysis was performed, and differences between groups were analyzed using independent samples t test. The non‐inferiority test was performed for HC. Results: At 4 months, the horizontal mean change (HC) was −1.43 mm (±0.53 mm) (DBBM‐C) and −1.32 mm (±0.53 mm) (DBBM). Change of the estimated soft tissue thickness (eTT) between baseline (BL) and four months of follow‐up (FU) at 1, 3, and 5 mm amounted to −4.58 mm (±2.02 mm), −2.40 mm (±0.97 mm), and −1.37 mm (±0.78 mm) for DBBM‐C and to −4.12 mm (±1.80 mm), −2.09 mm (±0.91 mm), and −1.23 mm (±0.72 mm) for DBBM. The differences between the groups were not statistically significantly for any of the outcome measures (p >.05). Conclusions: DBBM is non‐inferior to DBBM‐C for the maintenance of the soft tissue contour 4 months after tooth extraction. [ABSTRACT FROM AUTHOR]

Objectives: This randomized clinical trial analyzed the long‐term (5‐year) crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the anterior mandibular region at different depths (equi‐ and subcrestal). Materials and methods: Eleven edentulous patients were randomly divided in a split‐mouth design: 28 equicrestal implants (G1) and 27 subcrestal (1–3 mm) implants (G2). Five implants were placed per patient. All implants were immediately loaded. Standardized intraoral radiographs were used to evaluate crestal bone (CB) changes. Patients were assessed immediately, 4, 8, and 60 months after implant placement. The correlation between vertical mucosal thickness (VMT) and soft tissue recession was analyzed. Sub‐group analysis was also performed to evaluate the correlation between VMT and CB loss. Rank‐based ANOVA was used for comparison between groups (α =.05). Results: Fifty‐five implants (G1 = 28 and G2 = 27) were assessed. Implant and prosthetic survival rate were 100%. Subcrestal positioning resulted in less CB loss (−0.80 mm) when compared to equicrestal position (−0.99 mm), although the difference was not statistically significant (p >.05). Significant CB loss was found within the G1 and G2 groups at two different measurement times (T4 and T60) (p <.05). Implant placement depths and VMT had no effect on soft tissue recession (p >.05). Conclusions: There was no statistically significant difference in CB changes between subcrestal and equicrestal implant positioning; however, subcrestal position resulted in higher bone levels. Neither mucosal recession nor vertical mucosa thickness was influenced by different implant placement depths. [ABSTRACT FROM AUTHOR]

In recent years, extensive evidence has been published about usage of laser in oral lesions. The aim of the present study was to review the effectiveness of laser radiation in the treatment of pediatric oral soft tissue problems. The relevant keywords were searched in EBSCO, Medline (via Ovid), PubMed, Scopus, and Web of Science (WOS) databases. Then, eligible case series and controlled clinical trial studies, which published up to the end of 2018, were extracted and scrutinized. In this study, the age range of ≤ 21 years or the average age of ≤ 21 years was considered as the pediatric group. After limiting the search results, removing duplicate titles and eligibility evaluation, 17 papers were enrolled to the study (seven controlled clinical trials and ten case series). Er:YAG (2940 nm), CO2 (10,600 nm), Er,Cr:YSGG (2780 nm), and diode (650, 660, and 975 nm) lasers indicated successful clinical results on mucocele excision, frenectomy, gingival incision and re-contouring, and treatment of vascular malformations. In addition, 660-nm diode laser radiation was an effective adjuvant treatment for halitosis and gingivitis induced by multi-bracket appliances. Reduction or absence of pain and bleeding, suitable homeostasis, reduction of operation time, less analgesic consumption, and antibacterial effect were among the advantages of the laser radiation in the studies. Laser as a main or adjuvant tool can have an effective role in surgical and non-surgical treatments of pediatric oral soft tissue problems. Conducting further randomized controlled trial studies on different soft tissue lesions can contribute to drawing better conclusions. [ABSTRACT FROM AUTHOR]

Objective: Improved pain assessment and management in the emergency department (ED) is warranted. We aimed to determine the impact on pain management, of adding symptoms and signs to pain assessment.Patients and Methods: A single center before-and-after study was conducted, supplemented by an interrupted time series analysis. The intervention included the addition of clinical presentation (CP) of the injury and facial expression (FE) of the patient to pain assessment scales of patients with soft tissue injures. Pain intensity was categorized as: mild, moderate, and severe. We compared types of pain relief medications, use of strong opioids, and pain relief efficacy between pre and post intervention phases.Results: Before-and-after analysis revealed a significant reduction in the use of strong opioids. The adjusted relative ratio for the use of strong opioids in the post intervention phase was 0.63 (95% CI: 0.48-0.82). This reduction was mostly driven by less use of strong opioids in patients reporting severe pain (from 17.3%-7.9%) (P < 0.0001). A larger proportion of patients in the post intervention phase than in the pre intervention phase received weak opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) (27.4% vs 19.1%, P = 0.002), and a larger proportion did not receive any pain relief medication (19.8% vs 10.5%, p < 0.0001). The use of strong opioids increased with higher levels of FE and CP. Among patients with mild injury and reporting severe pain, the odds of receiving a strong opioid was nearly 9 times (OR = 8.9, 95% CI: 4.0-19.6) higher among those who were with an unrelaxed FE and showed pain behavior than those with relaxed FE. Interrupted time-series analysis showed that the mean ΔVAS (VAS score at entry minus VAS score at discharge) in the post intervention phase compared with the pre intervention phase was not statistically significant (P = 0.073). The use of strong opioids in the post intervention phase was significantly reduced (P = 0.017).Conclusion: Adding symptoms and signs to pain assessment of patients admitted with soft tissue injuries decreased the use of strong opioids, without affecting pain relief efficacy. [ABSTRACT FROM AUTHOR]

Purpose: The scientific literature concerning the anatomy of medial soft-tissue stabilizers of the patella is growing exponentially. Much of the surgical literature has focused on the role of the medial patellofemoral ligament (MPFL) and techniques to reconstruct it, yet our understanding of its anatomy has evolved during the past several years. Given this, we report on the current understanding of medial patellofemoral anatomy and implications for reconstruction.Methods: Current and historical studies of medial patellar anatomy were reviewed, which include the MPFL and medial quadriceps tendon femoral ligament (MQTFL), as well as that of the distal medial patellar restraints, the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML). In addition to the reported findings, the authors' anatomic descriptions of each ligament during their dissections were identified and recorded.Results: Despite the name of the MPFL, which implies that the ligament courses between the femur and patella, recent studies have highlighted the proximal MPFL fibers that attach to the quadriceps tendon, known as the MQTFL. The MPFL and MQTFL have also been referred to as the medial patellofemoral complex, reflecting the variability in anatomical attachment sites. The MPFL accounts for only half of the total restraint to lateral patellar displacement, and the remaining contributions to patellar stability are derived from the combination of the MPTL and MPML, which function primarily in greater degrees of knee flexion.Conclusion: The understanding of the complexity of the medial patellar stabilizers continues to evolve. Although MPFL reconstruction is gaining wide acceptance as a procedure to treat patellar instability, it is important to recognize the complex and changing understanding of the anatomy of the medial soft-tissue stabilizers and the implications for reconstruction.Level Of Evidence: V. [ABSTRACT FROM AUTHOR]

Cyst hydatid is a parasitic infectious disease caused by Echinococcosis. Even if the liver and lung are mainly affected organs, this cyst can be seen in every organ. Clinical presentation varies depending on the affected organ. We report here an unusual location of hydatid cyst, such as intermuscular septum of left scapular area. Sixty-five years of woman presented a swelling of left-back, and after surgery, her pathological diagnosis was hydatid cyst. Hydatid cyst is a common disease worldwide, and this disease is known to affect usually liver and lungs, but especially in endemic areas, every doctor should be aware when patients come to the clinic for soft tissue swelling of the different body areas. [ABSTRACT FROM AUTHOR]

Objective: Although foreign body injuries are common in the extremities, there is little information about treatment approaches in the literature. In this study, an epidemiological study of patients who underwent surgical treatment for foreign body ingestion in soft tissue was aimed. Methods: Between 2012 and 2015, a total of 109 patients (52 males and 57 females) who underwent surgical treatment for soft tissue foreign body injuries, received radiological images from the hospital archives and radiology PACS. Demographic data of the patients, type of foreign bodies sinking and submerged media, tetanus and antibiotic prophylaxis, anesthesia types, length of stay and complications were determined. Results: The mean age of 109 patients was 28 (3-68) years. In 62 (56.9%) patients, the injury occurred in the home environment and in 47 (43.1%) patients, foreign body sank in the external environment. Sinking foreign bodies were detected by needle in 43 patients, glass in 28 patients, metal body in 21 patients, metal foreign body as a result of gunshot injury in 12 patients and injury due to wooden component in 5 patients. The injuries were seen in 58.7% of the lower extremities and 41.3% in the upper extremity. While local anesthesia was applied to 78 (71.6%) patients who underwent surgery to remove foreign bodies, regional or general anesthesia was applied to the other patients. The patients who underwent local anesthesia were discharged on the same day, and general and regional anesthesia patients were discharged on the 1st postoperative day. No complications were observed during follow-up. Conclusion: Foreign bodies are mostly injuries in the home environment. Direct radiography is very useful in most of the foreign bodies, but ultrasonography and / or magnetic resonance imaging should be used to identify non-metallic foreign bodies. The type of anesthesia for surgical intervention should be based on the age of the patient and the localization of the foreign body. [ABSTRACT FROM AUTHOR]

Objective: To test whether or not topically administered recombinant human epidermal growth factor (rhEGF) accelerates the early healing phase of oral soft tissue wounds. Methods: One day following the creation of palatal defects (n = 6/animal), 14 dogs were allocated to one of the following five groups: spontaneous healing (SH), vehicle ointment (V), vehicle ointment + rhEGF at concentrations of 1 μg/g (EGF1), 10 μg/g (EGF10) or 50 μg/g (EGF50). Topical administration of ointments was repeated twice per day until sacrifice at days 8 and 16. Wound area was clinically monitored. Keratinocytes proliferation (Ki67‐immunolabelling), inflammatory response (IR) and areas of collagen (C) and granulation tissue (GT) were histologically measured. Kruskal–Wallis test with Dunnett correction was used for multiple group statistical comparisons. Results: Clinically, in comparison with SH, a significantly smaller wound area was observed in groups EGF1 and EGF10 at day 8 (p < 0.05). At day 16, wound closure reached 97.8% in group EGF1 compared to 83.2% in group SH, albeit no statistically different. Histologically, at day 8, significantly more GT was observed in group EGF10 compared to all other groups (p < 0.05). At day 16, in addition to a higher Ki67‐immunolabelling, groups EGF1 and EGF10 demonstrated a significant decrease in GT and IR with more deposition of C compared to the other groups (p < 0.05). Conclusion: Application of rhEGF enhanced the early healing of acute oral soft tissue wounds compared to SH, predominantly at concentrations of 1 and 10 μg/g. [ABSTRACT FROM AUTHOR]

Purpose: Open reduction and internal fixation (ORIF) using an extended lateral approach combined with plate osteosynthesis represents the current gold standard in calcaneal fracture treatment, but it is associated with a wound complication rate of up to 30%. Literature suggests that micro-circulation is one of the key factors for sufficient wound healing. The aim of this study was to evaluate soft tissue micro-circulation of the hindfoot in healthy volunteers to determine influencing factors and to identify hypoxic or hypoperfused areas in non-trauma situations, with special attention to surgical approaches.Methods: Micro-circulation of the lateral hindfoot of 125 participants was non-invasively measured at 2 and 8 mm depths, utilizing a Micro-Lightguide O2C® spectrophotometer. Blood flow (BF [AU]) and oxygen saturation (SO2 [%]) of ten measurement points (MPs) were documented. Demographic factors (age, gender, body mass index [BMI], systolic/diastolic blood pressure, smoking, and pack-years) and regional differences with special regard to surgical approaches (extended lateral approach, Palmer approach, Ollier approach, and a self-modified extended lateral approach) were analyzed.Results: The SO2 assessments at 2- and 8-mm depths revealed higher values in males (p = 0.043; p = 0.025). There was a correlation between higher age and lower 2 mm BF (p = 0.044). Smoking history and number of pack-years did not predict micro-circulation. BF at the 2 mm depth was highest in the regions of Palmer and Ollier approach (p < 0.001). The MP at the distal calcaneal tuberosity showed significantly higher values regarding all parameters (SO2 (2 mm), p < 0.001; SO2 (8 mm), p = 0.001; BF (2 mm), p < 0.001; BF (8 mm), p < 0.001), compared to the surrounding area.Conclusions: In non-trauma situations, young males were associated with better micro-circulatory supply of the lateral hindfoot. There was a trend for higher blood flow in regions of the Palmer and Ollier approach. The distal calcaneal tuberosity was clearly superior in all micro-circulatory parameters when compared to the surrounding area. [ABSTRACT FROM AUTHOR]

In some special surgeries, e.g., burnt necrotic tissue removing process and skin grafting process, the cutting edge of scalpel moves along the tangential direction of tissue surface to achieve the cutting of biological tissue. This cutting pattern, which is similar with the turning process of metal material, is essential different from the vertical cutting presented in literatures. As a first endeavor, the cutting characteristics along tangential direction of porcine tenderloin surface are investigated experimentally, where the bottom surface of tissue is fixed and the top surface is free. A set of advanced devices especially for ex vivo porcine tenderloin cutting, which can easily adjust the variable under different operating conditions, are designed and manufactured. The real-time device records quantitatively the cutting forces and tissue deformations, which is for evaluating the cutting energies and the fracture toughness, and analyzing the whole cutting process in detail. Additionally, a compression test device is designed for performing a standard component compression experiment, which is used to evaluate the tensile yield stress and the pain degree. A novel quantitative metric is proposed for predicting the pain degree (PDI) with a typical compression test. The relationship between the stress and the pain feeling is presented by the compression test of the particular sample. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To assess the profilometric changes of the buccal soft tissues between baseline and 5 years of loading using a one‐ and two‐piece dental implant system. Materials and methods: Sixty patients randomly received dental implants of either a two‐piece type (BRA) or a one‐piece type (STM). Casts were obtained at baseline (after crown insertion), at the 1‐year and at the 5‐year follow‐up. Stereolithography files were obtained from the casts for digital superimposition. One implant and the contralateral natural tooth were selected for the analysis. Thirty‐three patients (BRA = 16; STM = 17) were included. Measurements included changes for crown height (CH) and estimated soft tissue thickness, as well as the profilometric change at the implant and the tooth site. Nonparametric methods were applied for the statistical analyses and medians and quartiles presented. Results: The BRA group lost −0.39 mm and the STM group lost −0.40 mm of volume between baseline and the 5‐year follow‐up at the implant site (p > 0.05). The tooth site lost −0.18 mm (BRA) and −0.12 mm (STM) (p > 0.05). Volume differences between implants and teeth amounted to −0.05 mm (baseline to 1 year) and −0.25 mm (baseline to 5 years) for BRA, while for STM, the values were 0.03 mm (baseline to 1 year) and −0.16 mm (baseline to 5 years). The changes for implant CH at 1 and 5 years of follow‐up amounted 0.10 and 0.09 mm (BRA) and to 0.03 and 0.22 mm (STM). The changes in tissue thickness at 1 and 5 years in the BRA group amounted to −0.28 and −0.66 mm at 1 mm, −0.21 and −0.46 mm at 3 mm, and −0.32 and −0.45 mm at 5 mm, respectively. The changes in the STM group amounted to −0.15 and −0.54 mm at 1 mm, −0.24 and −0.48 mm at 3 mm, and −0.32 and −0.57 mm at 5 mm, respectively. No significantly different medians were observed. Conclusions: Minimal profilometric and linear changes occurred at implant sites between baseline and 5 years, between implant and tooth sites and between the two implant systems. [ABSTRACT FROM AUTHOR]

Objective The present split-mouth prospective study involves an immunohistochemical evaluation of peri-implant soft tissue healing after the osseointegration period, comparing submerged and transmucosal approaches using two-piece implant systems. The null hypothesis was that both surgical procedures elicit a similar immune response of the peri-implant soft tissues. Design Thirty-one healthy patients were included in this study, in which two implants were placed in the right and left maxillary pre-molar regions. A total of 62 dental implants were analyzed, establishing a control side with 31 submerged implants, and a study side with 31 exposed implants bearing healing abutments. After a three-month healing period, a soft tissue biopsy was collected and prepared for immunohistochemical analysis of the proportions of different lymphocyte subpopulations. Results The comparative analysis between the submerged and transmucosal approaches failed to identify statistically significant differences in CD19+ B cells, CD4+ T cells, CD8+ T cells, CD25+ T cells or γd T cells. However, significant differences in NK lymphocytes (p = 0.012) were recorded with the submerged surgical procedure. Conclusions Peri-implant soft tissue immune response with submerged or transmucosal healing protocols demonstrated comparable outcomes after the osseointegration period. There is sufficient evidence that the null hypothesis of no difference cannot be rejected. To the best of our knowledge, this is the first study of its kind. Further research is therefore needed to further clarify the role of these lymphocyte subpopulations in peri-implant soft tissues. [ABSTRACT FROM AUTHOR]

This review article on the current management for calcaneal fractures discusses the advantages and disadvantages of different treatment options including the problems encountered. Controversies are described and the evidence reviewed. The management of some types of displaced intra-articular calcaneal fractures remains contentious; is there a preferred stabilisation method for each type of calcaneal fracture? How constant is the “constant fragment” in an intra-articular calcaneal fracture and what is the evidence for primary arthrodesis and what is its place in these fractures? [ABSTRACT FROM AUTHOR]

Introduction: Tongue-type displaced intra-articular calcaneal fractures (DIACF) are associated with a specific pattern of fracture displacement in contrast to joint depression fractures. This may result in tension of soft tissue in the posterior part of the heel. Tension-induced ischemia can result in skin necrosis. The objectives of this study were to investigate whether patients with tongue-type calcaneal fractures exert a higher risk of complications, especially of the posterior soft tissues, than joint depression type fractures. Also, late interventions (e.g., antibiotics, debridements, and amputations) and the effect of timing of surgery on the complication rate was assessed.Methods: In this international retrospective cohort study, data of adult patients with a DIACF in the period January 1, 2005-December 31, 2015 were extracted from patients' medical files. Descriptive, univariate, and multivariable analyses were performed in SPSS.Results: A total of 560 patients with 632 DIACF were included (295 tongue-type and 337 non-tongue-type fractures). At hospital presentation, 20.3% of the patients with a tongue-type fracture had compromised posterior soft tissue versus 12.8% with non-tongue-type fractures (p = 0.032). However, corrected for potential confounders the risk was no longer statistically significant (OR 1.497; 95% CI 0.831-2.696). Patients with a TT-DIACF had a 1.2-3.4-fold higher rate of any local wound complication (deep infections, and full thickness lesions, p < 0.03). In addition they had 2.0-8.0-fold more intravenous antibiotics, debridements, soft tissue coverage procedures and amputations (p < 0.03). Patients who underwent surgery within two days after trauma had a higher risk to develop any complication, in particular superficial infections, when compared to surgery between 3-7 days, but no significant difference between 3 and 7 and ≥8 days could be demonstrated.Conclusion: Despite the fact that patients with a tongue-type fracture developed posterior skin and soft tissue compromise nearly twice as often, this difference disappeared after correction for confounders. The overall complication risk was increased in patients with tongue-type calcaneal fractures as compared to patients with a non-tongue-type fracture. Whether or not patients with tongue-type fractures require immediate surgery cannot be concluded from the data. [ABSTRACT FROM AUTHOR]

Background/aim: Prevalence and incidence of diabetes are increasing and many dental trauma patients today have diabetes. The implications of delayed wound healing, associated with diabetes mellitus, on oral mucosal wound healing have not been investigated extensively. The aim of this study was to investigate the implications of diabetes mellitus on the cellular, vascular, and fibroblastic changes induced by laceration on the oral mucosa of Wistar rats.Materials and Methods: Sixteen female Wistar rats were randomly assigned into two groups: 1. Experimental Streptozotocin-induced diabetic group (8 rats). 2. Control group (8 rats). A standardized laceration injury was induced from the corner of the mouth to the mid-check penetrating through dermal and oral mucosal contaminated by saliva. Samples were taken from the rats after sacrificing them on days 1,3,7, and 10. Inflammation was evaluated both qualitatively and quantitatively. Two investigators evaluated samples in a blinded manner.Results: Histology reports indicated delayed wound healing patterns in diabetic rats through days 1, 3, 7, and 10 when compared to controls. Inflammation was also noted to be consistently present more often in diabetic rats. Furthermore, polymorphonuclear cell count was consistently higher in diabetic rats.Conclusion: The results suggest that oral mucosa wound healing is delayed in diabetic Wistar rats compared to non-diabetic rats in terms of wound closure, angiogenesis, and polymorphonuclear cells number. Furthermore, it is also suggested that wound healing is impaired both in the early and late stages of soft tissue wound healing. [ABSTRACT FROM AUTHOR]

Background Several options have been described for soft-tissue reconstruction in Achilles tendon region (ATR). The best procedure should be customized according to any single case taking into account the number of structures involved, the quality of the neighboring skin, and patient's general condition. The aim of this article is to describe a simplified reconstructive algorithm based on personal experience and reviewing literature. Methods Forty-four patients, who underwent ATR soft-tissue reconstruction between 1998 and 2016, have been retrospectively reviewed. Etiologies of the defect include the following: 18 posttraumatic, 10 postoncologic, 14 dehiscence/infection, and 2 chronic ulcers. Follow-up ranges between 12 and 96 months. Free flaps have been used in 30 cases (including two secondary surgeries due to propeller flap failure) and propeller flaps have been used in 16 cases. Results Thirty-six flaps survived uneventfully (78.3%). Total flap necrosis occurred in three cases (6.5%), namely, two propeller flaps and one free flap. Partial necrosis of the flap was observed in seven cases (15, 2%): three in the free flap group and four in the propeller group. The functional recovery was very good in all the patients without involvement of the tendon and also all the patients who underwent a simultaneous reconstruction of the tendon with different techniques recovered a full weight bearing and a satisfactory range of motion. Conclusion Propeller flaps are a valuable option for skin reconstruction in case of defects of small andmediumsize not involving the tendon. In case of larger defects and when a simultaneous ATR reconstruction is required, a free flap seems to be a better option. [ABSTRACT FROM AUTHOR]

Soft tissue cutting is an important part of virtual surgery simulation training system,also is the common operation.The quality of soft tissue cutting model directly determines the accuracy and biofidelity of the virtual surgery simulation. To explore better dissection model of soft tissue,this paper analyzed the difficulties in researchs of soft tissue dissection in virtual surgery simulation. It studied the fourteen representative dissection models and based on these researches,it discussed advantages and disadvantages of these models and the development trend of dissection models of soft tissue. [ABSTRACT FROM AUTHOR]

Background Immediate implant placement followed by an immediate restoration has proven to be a viable technique in the anterior maxillary region. Purpose This prospective study evaluated the mid-long term (2-5 years) tissue changes around immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous hard tissue augmentation. Materials and methods Thirty AstraTech implants were immediately placed in 30 patients, followed by the delivery of an immediate provisional restoration on the same day. All participating 30 patients underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth, immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft, followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic Score (PES). Results All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15 months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae, respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES 10.27) ( P = .001). Conclusions In addition to a favorable implant success rate and peri-implant bony response, the soft tissue levels and overall aesthetics around single immediately placed and restored implants can also be maintained in the mid-long term. [ABSTRACT FROM AUTHOR]

Several optical-based techniques for measuring the sample thickness (ST) of soft tissues have been proposed in the literature to overcome the limits of hand-operated procedures. However, ST measurement still remains arbitrary. The stress calculated during an experimental procedure, usually based on a constant thickness value for all samples, cannot be considered representative of the actual stress experienced by the tissue. Therefore, a new optical methodology to measure ST is proposed and compared to four different thickness estimations. A simplified aortic geometry, under physiologic pulsatile conditions, is used to assess the impact of ST measurement on stress predictions. An additional computational model investigates the effect of such thickness values on critical pressure levels that may instigate aneurysm formation in a homogeneous or artificially modified geometry. Comparing the results obtained for the application of a pulsatile load, wall stress values associated to minimum ST are at least 24kPa inferior to maximum ST. Critical pressure values appear to be inversely proportional to ST estimation: simulations, associated to maximum ST, predict aneurysm formation for pressure levels at least 7kPa inferior to minimum ST outcomes. Finally, the role of the strain-energy function used to fit the experimental data is demonstrated to be fundamental for predictions of aneurysm formation. [ABSTRACT FROM AUTHOR]

Pressure ulcers are a type of local soft tissue injury due to sustained mechanical loading and remain a common issue in patient care. People with spinal cord injury (SCI) are especially at risk of pressure ulcers due to impaired mobility and sensory perception. The development of load improving support structures relies on realistic tissue load evaluation e.g. using finite element analysis (FEA). FEA requires realistic subject-specific mechanical properties and geometries. This study focuses on the effect of geometry. MRI is used for the creation of geometrically accurate models of the human buttock for three able-bodied volunteers and three volunteers with SCI. The effect of geometry on observed internal tissue deformations for each subject is studied by comparing FEA findings for equivalent loading conditions. The large variations found between subjects confirms the importance of subject-specific FEA. [ABSTRACT FROM PUBLISHER]

The first morphological observation of a euryalid brittle star, Asteronyx loveni, using non-destructive Xray micro-computed tomography (µCT) was performed. The body of euryalids is covered by thick skin, and it is very difficult to observe the ossicles without dissolving the skin. Computed tomography with micrometer resolution (approximately 4.5-15.4 µm) was used to construct 3D images of skeletal ossicles and soft tissues in the ophiuroid's body. Shape and positional arrangement of taxonomically important ossicles were clearly observed without any damage to the body. Detailed pathways inside the vertebral ossicles, lateral arm plates, and arm spines for passage of nerves and water vascular structures were observed. Inter-vertebral muscles were also observed. Forms and 3D arrangements of many important taxonomical characters of the euryali xonomy of the class Ophiu ds were scrutinized by µCT in high enough resolution for taxonomic description of ophiuroids. [ABSTRACT FROM AUTHOR]

Steerable needles can potentially improve the effectiveness of diagnostic and therapeutic procedures, such as biopsy and cancer treatment, by increasing the targeting accuracy and reaching previously inaccessible targets. A discrete potential field algorithm based on three dimensional (3D) anatomical structures is proposed in this paper to plan the needle path in minimally invasive surgery. A 3D kinematic model of needle steering is formulated using Lie group theory. Model parameters are fitted using experimental data acquired via a 2-degree of freedom robotic device and an ultrasound imaging device. To execute the paths with variable curvatures, the model is incorporated with duty cycled spinning. Empirical formula between needle curvature and duty cycled factor is obtained through insertion experiments. To improve the targeting accuracy, a path tracking algorithm is developed by correcting for the heading error and cross-track error of the needle tip. The targeting error of the simulation is 0.29 mm. We experimentally evaluate the path tracking model and it achieves an average targeting error of 1.15 ± 0.56 mm in 3D environments with anatomical obstacles. The results of simulation are in agreement with steering experiments, showing that the discrete potential field algorithm and path tracking model have the potential to improve targeting accuracy and advance the therapeutic and diagnostic procedures. [ABSTRACT FROM AUTHOR]

To assess signalment and outcome for dogs surgically treated for non-flattened femoral sulcus medial patellar luxation with combined soft tissue reconstruction techniques, cranial sartorius desmotomy, medial retinacular fascia release, patellar antirotational suture, and fascia lata overlapping, medical records from January 2006 to December 2015 were reviewed. Information obtained from medical records of cases in the study population included breed, age, sex, weight, type of patellar luxation (unilateral or bilateral), grade of patellar luxation, lameness score record, time of last followup, and time of luxation recurrent. The data were analyzed to determine factors influencing outcomes. Twenty-three dogs from 133 presented recurrent patellar luxation. A total of 12 from the 23 recurrent patellar luxation dogs were bilateral (52%) and 11 (48%) were unilateral. The time of recurrence after surgery varied from 1 month to 79 months. From the medical records as on the day of the study, it was found that the longest time that there was no recurrence in dogs was 10 years. It was found that, among the many factors, only grade 4 patellar luxation was a risk factor of considerable recurrence rate (OR=12.44, P=0.02). These results suggest that the combined four soft tissue reconstruction techniques demonstrated excellent outcome in the treatment of medial patellar luxation (with non-flattened femoral sulcus) in small breed dogs. At the same time, it can be stated that bone reconstruction technique is not always necessary. [ABSTRACT FROM AUTHOR]

In the field of soft tissue reconstruction, custom implants could address the need for materials that can fill complex geometries. Our aim was to develop a material system with optimal rheology for material extrusion, that can be processed in physiological and non-toxic conditions and provide structural support for soft tissue reconstruction. To meet this need we developed silk based bioinks using gelatin as a bulking agent and glycerol as a non-toxic additive to induce physical crosslinking. We developed these inks optimizing printing efficacy and resolution for patient-specific geometries that can be used for soft tissue reconstruction. We demonstrated in vitro that the material was stable under physiological conditions and could be tuned to match soft tissue mechanical properties. We demonstrated in vivo that the material was biocompatible and could be tuned to maintain shape and volume up to three months while promoting cellular infiltration and tissue integration. [ABSTRACT FROM AUTHOR]

Purpose: Impingement is a major source for decreased range of motion (ROM) and dislocation in total hip arthroplasty (THA). In the current study we analyzed the impact of soft tissue impingement on ROM compared to bony and/or prosthetic impingement.Methods: In the course of a prospective clinical trial 54 patients underwent cementless total hip arthroplasty in the lateral decubitus position using imageless navigation. The navigation device enabled intra-operative ROM measurements indicating soft tissue impingement. Post-operatively, all patients received postoperative 3D-CT. Absolute ROM without bony and/or prosthetic impingement was calculated with the help of a collision-detection-algorithm.Results: Due to soft tissue impingement we found a reduced ROM of over 20° (p < 0.001) compared to bony and/or prosthetic impingement regarding flexion, extension, abduction and adduction and of over 10° regarding external rotation (p < 0.001). In contrast, soft tissue impingement showed less impact on internal rotation in 90° of flexion (p = 0.76). Multivariate analysis showed an association between BMI and flexion, whereas all other ROM directions were independent of BMI.Conclusions: Soft tissue has a major impact on impingement-free ROM after THA. For the majority of movements, soft tissue restrictions are more important than bony and prosthetic impingement. Future models of patient individual joint replacement including pre-operative (CT) planning and intra-operative navigation should include algorithms additionally accounting for soft tissue impingement. [ABSTRACT FROM AUTHOR]

Background: Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment.Methods: Surgeons were asked to complete an online questionnaire consisting of 45 items developed by an expert consensus. The first part covered questions on general principles of open fracture management. The second part included questions on soft tissue management, the preferred method of initial surgical stabilisation, microbiological testing, employment of pulsatile lavage and local antibiotics, antibiotic regimen, second-look operations, and blood testing.Results: Of 653 respondents, 364 (65 %) completed the first part and 314 (48 %) completed the second part of the online survey. 55 % answered that a standard operating procedure for the diagnosis and treatment of patients with open fractures exists in their hospital. Only 25 % leave pre-hospitalisation applied dressings intact until arrival of the patient in the operating room, and 40 % make this decision depending on information provided by pre-hospitalisation emergency personnel. 84 % participants exclude the use of antibiotic-coated implants in the treatment of open fractures. The favoured stabilisation method in Gustilo type I fractures is definitive internal osteosynthesis and primary wound closure for 61 % of respondents. In Gustilo type II (74 %) and type III fractures (93 %), temporary external fixation is preferred. High-pressure pulsatile lavage is used by 22 % responding surgeons in Gustilo type I fractures, 53 % for type II fractures and 67 % for type III fractures.Conclusions: Open fracture management differs considerably among surgeons in Germany. Further studies are needed to deliver high-quality evidence concerning primary fracture stabilisation, soft tissue management and second-look operations. Existing evidence-based recommendations for general treatment, antibiotic prophylaxis and soft tissue management should be followed more strictly in clinical practice. [ABSTRACT FROM AUTHOR]

Background The cross-sectional area (CSA) of a material is used to calculate stress under load. The mechanical behaviour of soft tissue is of clinical interest in the management of injury; however, measuring CSA of soft tissue is challenging as samples are geometrically irregular and may deform during measurement. This study presents a simple method, using structured light scanning (SLS), to acquire a 3D model of rabbit Achilles tendon in vitro for measuring CSA of a tendon. Method The Artec Spider™ 3D scanner uses structured light and stereophotogrammetry technologies to acquire shape data and reconstruct a 3D model of an object. In this study, the 3D scanner was integrated with a custom mechanical rig, permitting 360-degree acquisition of the morphology of six New Zealand White rabbit Achilles tendons. The reconstructed 3D model was then used to measure CSA of the tendon. SLS, together with callipers and micro-CT, was used to measure CSA of objects with a regular or complex shape, such as a drill flute and human cervical vertebra, for validating the accuracy and repeatability of the technique. Results CSA of six tendons was measured with a coefficient of variation of less than 2%. The mean CSA was 9.9±1.0 mm 2 , comparable with those reported by other researchers. Scanning of phantoms demonstrated similar results to μCT. Conclusion The technique developed in this study offers a simple and accurate method for effectively measuring CSA of soft tissue such as tendons. This allows for localised calculation of stress along the length, assisting in the understanding of the function, injury mechanisms and rehabilitation of tissue. [ABSTRACT FROM AUTHOR]

The Early Devonian of Podolia, Ukraine, has yielded phosphatized colonies of the boring ctenostome bryozoan Podoliapora doroshivi with 3-D preservation of soft tissues. However, the feeding zooids are not anatomically complete, their preserved soft tissues comprising decay-resistant structures such as the protective cuticular polypide sacs with presumed parietal muscles inside the wall of the sacs, the setigerous collars, the membranous orificial walls and remains of the muscle tissues. Early diagenetic apatite mineralization occured in numerous feeding zooids of Podoliapora at different stages of decay and may be important for the interpretation of decay processes in these colonial soft-bodied fossil organisms. A setigerous collar, which is a characteristic of extant ctenostomes, occurs in P. doroshivi in several stages of decay showing progressive collapse and eventual complete loss. This study indicates that the morphological changes of collars induced by decay often resulted in connection with the membranous orificial wall, producing false anatomical structures, unrelated to structures observed in the earlier stages of decay or to the anatomical structures of extant ctenostomes. The most decay-resistant cuticular polypide sacs mineralized as cryptocrystalline apatite in early stage of decay became degraded in later stages of decay. These data provide evidence that the anatomical interpretation of soft-bodied fossils preserved only in the later stages of decay may have led to imprecise morphological interpretations. [ABSTRACT FROM AUTHOR]

Background/aim: Soft tissue injuries (STI) are common in children and adolescents. This retrospective study evaluated the frequency of STI, gender, type of injury, and its location in pediatric patients, comparing the different age groups and how the presence of these lesions influences the pursuit for immediate care.Material and Methods: Medical records of patients 0-15 years old who had been treated between 2005 and 2013 at the Dental Trauma Surveillance Center, School of Dentistry, Universidade Federal do Rio de Janeiro were included in this study. Records with incomplete data and those in which the patient took more than 2 weeks to seek attendance were excluded. The data collected included the age and gender of the patient, the frequency, type and location of the injury, and immediate treatment (<24 h). Data were analyzed descriptively and with the chi-square test (P ≤ 0.05).Results: Of the 543 patients who met the eligibility criteria, 56.2% had STI, and males (65.6%), and the age group of 0-3 years (39.7%) were the most affected. The concomitant presence of lesions in the intra- and extra-oral region was the most frequent in all age groups. In the extra-oral region, contusion (20.7%) and abrasion (19.3%) were more common to the upper lip and laceration to the lower lip (18.4%). In the intra-oral region, the injury was more frequent to the gums (41%), while the lips were the most affected by abrasion (12.2%) and laceration (24.9%). Regardless of the age groups, the pursuit for immediate care was statistically influenced by the presence of soft tissue lesions (P < 0.05).Conclusion: We conclude that there is a high prevalence of STI in the study sample; the lesions were more common in boys and in patients aged 0-3 years. The presence of STI proved to be a determining factor for the pursuit for immediate care. [ABSTRACT FROM AUTHOR]

The walls of the blood vessels involved with cerebral aneurysms present different mechanical properties, when compared with those of normal artery. Consequently the models which may describe then predict an aneurysm rupture need as input their mechanical properties. This paper describes the experimental determination of the mechanical properties of the tissues of the blood vessels affected with a cerebral aneurysm. In particular, we determine and discuss the critical elongation and the rupture strength. The affected tissues were obtained from surgical clipping and extraction; six specimens were tested. The mechanical tests were performed in a tensile device. The experimental data was fitted numerically with a Mooney-Rivlin hyper elastic model. The model was compared with previous published data. [ABSTRACT FROM AUTHOR]

Virtual surgery simulators show a lot of advantages in the world of surgery training, where they allow to improve the quality of surgeons’ gesture. One of the current major technical difficulties for the development of surgery simulation is the possibility to perform a real-time computation of soft tissue deformation by considering the accurate modeling of their mechanical properties. However today, few models are available, they are still time consuming and limited in number of elements by algorithm complexity. We present in this paper a new method and framework that we call ‘HEML’ ( Hyper-Elastic Mass Links ), which is particularly fast. It is derived from the finite element method, can handle visco-hyperelastic and large deformation modeling. Although developed initially for medical applications, the HEML method can be used for any numerical computation of hyperelastic material deformations based on a tetrahedral mesh. A comparison with existing methods shows a much faster speed. A comparison with Mass–Spring methods, that are particularly fast but not realistic, shows that they can be considered as a degenerate case of the HEML framework. [ABSTRACT FROM AUTHOR]

Background: Image-guided percutaneous core needle biopsy (PCNB) of soft-tissue lesions is a minimally invasive technique that can provide a definitive diagnosis for treatment. Anatomical and age considerations in children require judicious use of safe percutaneous biopsy techniques. There are, however, limited data on the determinants of diagnostic yield in soft-tissue lesions in this population. Objectives: To assess lesion-related and technical factors that affect diagnostic yield and safety in PCNB of pediatric soft-tissue lesions. Materials and methods: This was a retrospective cohort study of 205 PCNB performed from January 2000 to July 2014. Diagnostic yield and its associations with technical and lesion-related factors were evaluated using bivariate analysis. Results: The mean patient age was 11.1 ± 6.9 years (interquartile range [IQR]: 4.3-16 years). Ultrasound guidance alone was used in 91% of cases. The mean number of passes was 7.5 ± 3.2 (IQR: 5-9 passes) per case. The overall diagnostic yield was 75% and the overall accuracy was 88%. Performing fewer than four passes was associated with a nondiagnostic biopsy ( P = 0.001). There were no lesion or other technical factors that predicted a diagnostic biopsy. There were two complications (1%) over 14 years. Conclusion: Image-guided PCNB is a safe and effective means for the diagnosis of pediatric soft-tissue abnormalities. Aside from performing at least four passes, our data show no technical or lesion-related factors that increase diagnostic yield in pediatric PCNB of soft-tissue lesions. [ABSTRACT FROM AUTHOR]

Extremity injuries comprise the majority of battlefield injuries and contribute the most to long-term disability of servicemembers. The purpose of this study was to better define the contribution of muscle deficits and volumetric muscle loss (VML) to the designation of long-term disability in order to better understand their effect on outcomes for limb-salvage patients. Medically retired servicemembers who sustained a combat-related type III open tibia fracture (Orthopedic cohort) were reviewed for results of their medical evaluation leading to discharge from military service. A cohort of battlefield-injured servicemembers (including those with nonorthopedic injuries) who were medically retired because of various injuries (General cohort) was also examined. Muscle conditions accounted for 65% of the disability of patients in the Orthopedic cohort. Among the General cohort, 92% of the muscle conditions were identified as VML. VML is a condition that contributes significantly to long-term disability, and the development of therapies addressing VML has the potential to fill a significant void in orthopedic care. [ABSTRACT FROM AUTHOR]