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The development of additive manufacturing and lattice structures has created opportunities for the development of lightweight impact–absorption structures that can overcome most constraints of previously used materials such as expanded polystyrene foams. However, for the successful application of such structures, the effects of their variables in their mechanical performance must be established. In this study, the mechanical properties and energy absorption of thermoplastic sheet gyroid structures were investigated and compared with the performance of current materials. Consequently, the specimens were tested after changing the main variables, i.e., cell size and volume fraction, of various thermoplastic materials such as acrylonitrile butadiene styrene, polylactic acid, thermoplastic polyurethane, and polyamide 12. Finally, they were tested in a quasi-static compression test and their deformation stages were photographed. The stress–strain curves of all materials changed after adopting the sheet gyroid structure, exhibiting three distinct regions: linear elastic, long collapse plateau, and densification that made them particularly applicable for energy absorption. Volume fraction affected the layer collapse. The elastic geometrical stiffness increased for higher volume fractions and smaller cells. In addition, the peak and plateau stresses increased at higher volume fractions, and while smaller cells were not directly affected. Additionally, the area under the curves increase with the volume fraction; hence, for most materials, specific energy absorption was larger for higher volume fractions. The constituent material properties contributed significantly to the structural behavior, exhibiting three primary deformation mechanisms, i.e., elastomeric, elastic–plastic, and elastic–brittle, resulting in a wide spectrum of properties for each application requirement. The comparison of the optimal properties with the expanded polystyrene demonstrated the ability of sheet gyroid structures to overcome most of its challenges, exhibiting a superior specific energy absorption, ability to withstand various impacts, letting air flow in its all axes, and being recyclable. Thus, sheet gyroid structures can be considered promising alternatives. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus infections are a significant cause of morbidity and mortality in pediatric populations worldwide. The Staphylo Research Network conducted an extensive study on pediatric patients across Colombia from 2018 to 2021. The aim of this study was to describe the epidemiological and microbiological characteristics of S. aureus in this patient group., Methods: We analyzed S. aureus isolates from WHONET-reporting centers. An "event" was a positive culture isolation in a previously negative individual after 2 weeks. We studied center characteristics, age distribution, infection type, and antibiotic susceptibilities, comparing methicillin sensitive (MSSA) and resistant S. aureus (MRSA) isolates., Results: Isolates from 20 centers across 7 Colombian cities were included. Most centers (80%) served both adults and children, with 55% offering oncology services and 85% having a PICU. We registered 8,157 S. aureus culture isolations from 5,384 events (3,345 MSSA and 1,961 MRSA) in 4,821 patients, with a median age of 5 years. Blood (26.2%) and skin/soft tissue (18.6%) were the most common infection sources. Most isolates per event remained susceptible to oxacillin (63.2%), clindamycin (94.3%), and TMP-SMX (98.3%). MRSA prevalence varied by city (<0.001), with slightly higher rates observed in exclusively pediatric hospitals. In contrast, the MRSA rate was somewhat lower in centers with Antimicrobial Stewardship Program (ASP). MRSA was predominantly isolated from osteoarticular infections and multiple foci, while MSSA was more frequently associated with recurrent infections compared to MRSA., Conclusions: This is the largest study of pediatric S. aureus infections in Colombia. We found MSSA predominance, but resistance have important regional variations. S. aureus remains susceptible to other commonly used antibiotics such as TMP-SMX and clindamycin. Ongoing monitoring of S. aureus infections is vital for understanding their behavior in children. Prospective studies within the Staphylored LATAM are underway for a more comprehensive clinical and genetic characterization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Gutierrez-Tobar, Carvajal, Vasquez-Hoyos, Díaz-Díaz, Londono Ruiz, Andrade, Camacho-Cruz, Restrepo-Gouzy, Trujillo-Honeysberg, Mesa-Monsalve, Perez, Von Moltke, Beltran-Echeverry, Toro, Niño, Camacho-Moreno, Calle-Giraldo, Cabeza, Sandoval-Calle, Perez Camacho, Patiño Niño, Araque-Muñoz, Rodríguez-Peña, Beltran-Arroyave, Chaucanez-Bastidas, Lopez, Galvis-Trujillo, Beltrán-Higuera, Marino, González Leal, Luengas Monroy, Hernandez-Moreno, Vivas Trochez, Garces and López-Medina.)

Objective: Clinical practice guidelines (CPG) worldwide help steer the management of early-onset neonatal sepsis (EONS). These documents typically discourage the use of risk assessment tools. However, prior work has shown that the Kaiser Permanente calculator (Early-Onset Sepsis Calculator [EOScalc]) could be a useful tool in EONS risk assessment. This study aimed to determine the agreement between the recommendations of the Colombian EONS CPG and those of the EOSCalc tool in a cohort of newborns in Bogotá, Colombia., Study Design: Multicenter retrospective observational cohort study. We included newborns with a gestational age ≥ 34 weeks who were admitted to the neonatal care unit with a suspected diagnosis of EONS between 2017 and 2019. Agreement between the two tools was examined using Cohen's kappa under two scenarios (unequivocal and cautious)., Results: Of the 23.490 live births, 470 (1.71%) were admitted to the neonatal care unit with a presumptive diagnosis of EONS. This diagnosis was confirmed in seven patients by means of blood cultures, with group B streptococcus the most common organism (57%; 95% confidence interval [CI]: 18.4-90.1). A single death occurred among the patients with confirmed EONS (lethality: 14.3%). The overall incidence of EONS was 0.298 per 1,000 live births. After splitting the recommendations into two scenarios regarding antibiotic use, unequivocal and cautious, the agreement between EOSCalc and the CPG was below 15% (6 and 14%, respectively)., Conclusion: Recommendations from the Colombian EONS CPG show poor agreement with the EOSCalc, with the latter detecting all newborns with EONS. Although the use of EOSCalc is clinically and administratively advantageous, further prospective studies are warranted to determine the safety of its implementation., Key Points: · Colombian EONS CPGs recommend that an outsized number of newborns be given antibiotics.. · The KP EOSCalc risk assessment calculator shows poor agreement with CPG recommendations.. · The Colombian CPGs should be updated to include the use of risk assessment calculators.., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012., Methods: Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination., Results: A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period., Conclusions: PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype., Competing Interests: Declaration of Competing Interest IFGT: Has received support for participation in congresses and conference payments from Pfizer. CMD: Has received support from Pfizer for participation in congresses. SBH: Has received support from Pfizer for participation in congresses. GCM: Has received support for participation in congresses and conference payments from Pfizer and MSD (Merck Sharp and Dohme), has participated on the MSD advisory board and has received support from MSD for other research. ALLC: Has received support from Pfizer for participation in congresses and has received support from MSD for other research. JAPN: Has received support for participation in congresses and conference payments from Pfizer. MIA: Has received support from Pfizer for participation in congresses. FE reports a relationship with Merck Sharp & Dohme Ltd that includes: funding grants. RBB reports a relationship with Pfizer that includes: board membership. NR: Has received support from Pfizer for participation in congresses. AM: Has received support from MSD for other research. JPL, MAS, VMMM, AM, CRSP, AP: do not declare a conflict of interest., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The irradiation of ( Z )-2-phenyl-4-aryliden-5(4 H )-thiazolones 2 with blue light (465 nm) in CH 2 Cl 2 solution promotes [2 + 2]-photocycloaddition of the exocyclic C═C bonds and the formation of the dispirocyclobutanes 3 . This reaction takes place with high stereoselectivity, given that the ε-isomer (1,3 head-to-tail syn coupling) is formed in more than 90% yield in most of the cases. However, irradiation of 5(4 H )-thiazolones 2 with blue light (456 nm) in dry MeOH in the presence of BF 3 ·OEt 2 leads to the monospirocyclobutanes 4 with full stereoselectivity, also affording the ε-isomer. A ring-opening reaction of only one of the thiazolone rings appears to have taken place in 4 upon methanolysis, leading to the corresponding ester and thioamide groups. The treatment of free 4-aryliden-5(4 H )-thiazolones 2 with a base in alcohol (NaOR/ROH) also produces a ring-opening reaction of the heterocycle by methanolysis, although, under these reaction conditions, further intramolecular S-attack at the exocyclic C(H)═C bond and cyclization is observed, forming the dihydrothiazoles 5 or 6 as mixtures of cis ( RS / SR )- and trans ( RR / SS )-isomers with high diastereomeric excess. trans -( RR/SS )-Dihydrothiazoles 6 can be isolated as pure diastereoisomers by column chromatography. Surprisingly, dihydrothiazoles 5 can also be obtained by the treatment of 4-aryliden-5(4 H )-thiazolones 2 with BF 3 ·OEt 2 in methanol in the absence of a base.

Objective: To evaluate the biological effect of microengineered stent grooves (MSG) on early strut healing in humans by performing optical coherence tomography (OCT) analysis 3 weeks following the implantation., Background: In the experimental setting, MSG accelerate endothelial cell migration and reduce neointimal proliferation compared with bare metal stent (BMS)., Methods: A total of 37 patients undergoing percutaneous coronary intervention with de novo coronary lesions were randomly assigned to either MSG (n=19) or an identical BMS controls (n=18). All patients underwent OCT imaging at 3 weeks. A total of 7959 struts were included in the final analysis., Results: At 3 weeks following stent implantation, almost all struts analysed (~97%) had evidence of tissue coverage. The percentage of partially covered struts was comparable between both groups. However, the percentage of fully embedded struts was higher in the BMS group (81.22%, 49.75-95.52) compared with the MSG group (74.21%, 58.85-86.38). The stent-level analysis demonstrated reduction in neointimal formation (neointimal hyperplasia area and volume reduction of ~14% and ~19%, respectively) in the MSG versus the BMS group. In the strut-level analysis, an even greater reduction (~22% in neointimal thickness) was seen in the MSG group. Layered neointimal was present in ~6% of the OCT frames in the BMS group while it was not present in the MSG group., Conclusions: MSG induced a more homogeneous and predictable pattern of surface healing in the early stages following stent implantation. The biological effect of MSG on stent healing has the potential to improve the safety profile of current generation drug-eluting stents., Classifications: BMS, OCT, clinical trials., Competing Interests: Competing interests: None declared.

Aims: Bioresorbable polymer drug-eluting stent technologies have been considered to have the potential to enhance vascular healing by reducing polymer exposure to the vessel wall, potentially allowing the earlier discontinuation of dual antiplatelet therapy. At present, the early vascular healing response to this type of technologies is still unclear., Patients and Methods: The TIMELESS study is a multicenter, prospective, single-arm study that enrolled real-world patients undergoing percutaneous coronary intervention. All patients underwent Synergy stent implantation, which consists of a platinum-chromium platform coated with an ultra-thin abluminal bioabsorbable poly-D,L-lactide-co-glycolide polymer-eluting everolimus., Results: A total of 37 patients were included in the study. The majority of the patients underwent percutaneous coronary intervention because of acute coronary syndromes. At 3 months, angiographic follow-up showed a percentage diameter of stenosis of 8.1±7.5% and an angiographic late loss of 0.03±0.24 mm. In all analyzed struts, less than 1% of struts were definitely uncovered or covered with fibrin, 12.5% (5.0-18.5%) showed evidence of partial coverage, and the remaining (∼85%) were fully covered. No stent thrombosis was observed up to 12 months of clinical follow-up., Conclusion: In a real-world population, the implantation of a bioresorbable polymer drug-eluting stent resulted in almost complete strut coverage throughout the entire stent length at 3 months. The clinical implications for antiplatelet therapy and outcomes should be investigated further.

The Guillain-Barré syndrome (GBS) is the most common cause of acute generalized paralysis. GBS is an acute inflammatory demyelinating polyradiculoneuropathy. It usually presents as a paralysis that starts in the lower limbs and then progresses symmetrically upward. The present study reports a case of bilateral facial palsy as the initial manifestation of GBS. This is a report of a case of a 37-year-old male, diabetic, that eight days after having suffered acute sinusitis, gradually presented with right hemicranial headache, dysarthria and sialorrhea. The neurological examination disclosed the absence of the bilateral frontal folds, accompanied by epiphora, bilateral lagophthalmos, bilateral Bell sign and salivary drooling through both commissures of lips. At 48 hours after hospital admission the patient showed paresis in both upper limbs. The cerebrospinal fluid analysis reported 1.1cells/mm3, fully represented by lymphocytes of normal aspect and total proteins were 196.9 mg/dL. The electromyography was consistent with acute demyelinating polyneuropathy, with a predominant motor component and a major facial involvement. With the clinical and laboratory findings, a diagnosis of GBS was established. Treatment was started with plasmapheresis and intravenous immunoglobulin, with the subsequent improvement of the clinic. The facial diplegia is part of the regional variants of GBS. Although about 60% of GBS patients present with facial weakness, it is usually preceded by weakness in the limbs. This case makes evident that GBS may present clinically as a facial diplegia.

Testicular autotransplantation is an advanced technique for the correction of high intra-abdominal testicles with inadequate vascular length for repositioning in the scrotum. In the past, surgeons have often avoided this approach due to the extended operative time and the requirement for microsurgical equipment and training. Surprisingly, this procedure remains rare despite the fact that autotransplantation is sometimes the most viable option to relocate the testicle. Further, current advances in laparoscopic surgery allow for testicular harvesting with minimal morbidity and maximal vascular pedicle length. Here, the evolution and an approach combining these two techniques implemented successfully in five patients are presented., (© Thieme Medical Publishers.)

Chagasic megacolon has been reported in the southern cone countries of South America and is mainly associated with Trypanosoma cruzi II infection. Herein, we report the first case in Colombia of chagasic megacolon with cardiomyopathy associated with the T. cruzi I lineage. This finding suggests that in Colombia, as well as in other northern countries of South America and throughout Central America, where T. cruzi I is endemic, cardiomyopathy may not be the only clinical form of Chagas disease.

Background/purpose: Over 50 years ago, current tenets of distraction osteogenesis were developed through work on the lower extremity; however, the application of these tenets in the paediatric craniofacial skeleton remains questionable. Prompted by recent concern that traditional aspects of distraction may be either outdated or wholly inapplicable to the paediatric maxilla, we retrospectively evaluated maxillary distraction protocol using a 24-h latency period in conjunction with a distraction rate of 2mm/day., Methods: Following maxillary advancement via a distraction protocol consisting of a 24-h latency period and a distraction rate of 2mm/day, seven consecutive paediatric cases were evaluated. Standard profile photos and cephalometric films taken preoperatively, at device removal and at 1-year follow-up were compared. With the sella as the point of registration, pre- and post-distraction films were superimposed on the sella-nasion plane. Sella-nasion-subspinale, the angle of convexity, the distance from incisal edges to the y-axis, and angulation of the upper incisor to the sella-nasion plane were analysed to evaluate hard-tissue changes., Results: Patient age ranged from 3 to 14 years (mean=7.43 years). Maxillary distraction length averaged 11 mm (range=10-12 mm). Interval from device application to removal averaged 98 days (range=75-180 days). The interval of the active distraction ranged from 11 to 65 days (mean=24 days). From distraction completion to device removal averaged 85 days (range=60-150). Follow-up intervals ranged from 52 to 24 months (mean=34 months). All patients demonstrated substantial clinical advancement of the maxilla with correction of midfacial deficiencies. A single patient developed mild cellulitis at one skin-device interface; no other complications were noted. Cephalometric and clinical evaluations at 1 year post-distraction demonstrated stable results, and parental satisfaction was qualitatively high., Conclusions: The surgical dogma of lower-extremity distraction osteogenesis is not absolute and may not be optimal for use in the paediatric maxilla. Our results demonstrate effective maxillary correction following application of a 24-h latency period coupled with rapid distraction at 2mm/day. Our success with a short latency period and more rapid device expanse may be a product of the significant vascularity and improved healing potential of the paediatric maxilla.

In the United States, rhinoplasty has traditionally been performed in Caucasian patients. Ethnic rhinoplasty is often thought of as a procedure done to reshape the nose of a black or Asian patient. Little attention has been paid to rhinoplasty in Hispanic patients. There has been a large increase in the Hispanic population of the United States, and plastic surgeons will see a concomitant rise in requests for rhinoplasty among this population. In an effort to increase our understanding of Hispanic rhinoplasty, a retrospective review of a senior surgeon's experience was performed. A retrospective chart review was done examining the senior author's (S.S.) rhinoplasty practice over the past 10 years. Hispanic patients presenting for aesthetic and corrective rhinoplasty (cleft patients were excluded) were analyzed. The Hispanic nose was divided into three archetypes. Type I is characterized by a high radix and prominent vault; these noses should be corrected by dorsal reduction and resection of caudal septum. Type II is characterized by a dependent tip with inadequate projection; dorsal augmentation with diced cartilage and tip support with cartilage grafts are important. Osteotomies should generally be avoided in this group. Type III noses are characterized by a broad nasal base with thick skin and a wide tip; rhinoplasty in this group requires correction of the dorsum-base disproportion using several techniques including columellar struts, tip grafts, and dorsal augmentation. Hispanics are projected to become the largest minority population within the next 10 years, and rhinoplasty in this population will become more frequent over time. It behooves plastic surgeons to become familiar with the different archetypes of Hispanic noses and appropriate corrective techniques for each.

Of all the methods for repair of the unilateral cleft lip, none has gained as much popularity as the rotation-advancement. Millard's original principle of 50 years ago continues to guide surgeons in closure of the cleft lip. Unlike earlier procedures, the brilliance of the rotation-advancement is that it permits individual manipulation and modifications while maintaining Millard's original surgical and anatomical goals. Millard and many other surgeons have made modifications to adjust the procedure to each specific patient, to address some of its faults, and to gain new advantages. In this article, the authors review the techniques of Drs. Ralph Millard, Steve Byrd, Court Cutting, John Mulliken, and Samuel Stal. The variations from Millard's original technique are highlighted, including a discussion of the benefits of each modification.

There are few published reports of the results of supravalvular aortic stenosis correction with the use of Brom's 3-patch technique. Herein, we report our use of this procedure and the short-term results therefrom.From 2002 through 2007, 9 children underwent surgical correction of localized supravalvular aortic stenosis at our hospital. The patients ranged in age from 5 to 14 years, and 8 had Williams syndrome. All operations were performed by the same surgical team.No clinically significant associated cardiac anomalies were encountered. Each aortic repair involved the use of pericardium, Dacron, or both. One patient had an uncorrected right coronary artery obstruction and died postoperatively of refractory supraventricular tachycardia. In all 8 patients who survived, postoperative transaortic blood pressure gradients were improved (range, 0-16 mmHg), and no repeat operations were needed after 6 to 55 months' follow-up.We consider Brom's technique to be safe in the repair of supravalvular aortic stenosis. In our limited series, it produced effective anatomic restoration, with good short-term and potentially good long-term results.

As the most prominent facial feature, the nose carries an increased risk of traumatic injury. Nasal fracture is the most common bone injury of the adult face and frequently results from motor vehicle accidents, sports-related injuries, and altercations. Although often initially considered minor, nasal fracture may eventually result in significant cosmetic or functional defects. Optimal management of nasal trauma in the acute setting is critical in minimizing secondary nasal deformities. In recent years, numerous guidelines have been described to refine and optimize acute nasal trauma management. However, restoration of pretraumatic form and function remains a challenge. Commonly the product of a poorly addressed underlying structural injury, posttraumatic nasal deformity requiring subsequent rhinoplasty or septorhinoplasty remains in as many as 50 percent of cases. In this article, the authors review the anatomic, diagnostic, and management considerations as well as discuss their own experience in approaching nasal trauma and the deviated nose.

Pediatric vascular anomalies can be difficult to diagnose and complex to treat. One must be able to distinguish hemangiomas from various vascular malformations, as well as appreciate their dynamic course with time. Thorough understandings of the clinical and diagnostic techniques used to evaluate these lesions are paramount for the treating surgeon. In addition, knowledge of current treatments from watchful waiting to radical extirpation is mandatory. This must all be done in the setting of a developing child. We present a current review of the literature regarding the comprehensive care of pediatric vascular lesions.

Background: Distraction osteogenesis was initially devised as a way to lengthen the lower extremity. All the basic tenets of the technique were developed based on this use. This includes both the supposed need for a latency period before distraction begins (3 to 5 days) and the ideal rate of distraction (1 mm/day). There is no evidence that these values apply to craniofacial distraction osteogenesis, particularly in children. Indeed, with the markedly improved blood supply in the face when compared with the lower extremity and the use of the technique in children versus adults, one might assume that a shorter latency period and a more rapid rate of distraction are possible., Methods: This study is a retrospective review of 22 pediatric patients with mandibular hypoplasia undergoing mandibular distraction osteogenesis. All patients were operated on by a team consisting of an oral surgeon and a plastic surgeon. All the distraction devices used were external. All patients had a latency period, before activation, of less than 24 hours and a distraction rate of 2 mm/day., Results: Two patients developed cellulitis at the pin sites, one patient developed premature healing, one patient developed a nonunion that required further surgery. This was the only patient in the series who had distraction of a previous bone graft. No patient undergoing distraction of native mandible developed a nonunion., Conclusions: Eliminating the latency period and rapidly distracting the mandible in pediatric cases has an acceptably low complication rate. This benefits the patient in terms of an overall reduction in the amount of time that the child needs to remain in the distraction device. The patient spends less time with the distraction device, thus reducing the potential morbidity and increased cost of the treatment. Potential explanations for why this variation in distraction technique is successful include the improved blood supply in the face of children and the failure of external devices to translate all the distracted movements to the bone interface. Some of this force is translated into both bending of the pins and migration of the pins through bone. Although a latency period might be necessary in the distraction of the lower extremities, the application of this concept to the craniofacial skeleton in children is erroneous.

Plexiform neurofibromas traditionally have posed a surgical challenge in pediatric patients. Expert preoperative planning, advanced surgical techniques, and vigilant postoperative care results in minimal morbidity and resolution of tumor symptomatology. A retrospective review of four consecutive pediatric patients with massive head and neck neurofibromas who underwent single-stage total or near-total removal of their tumors was performed. All four patients had obstructive airway symptoms. There were two minor complications. All patients had complete relief of their symptoms and return of function without any additional neurologic deficits. It is possible to safely achieve total or near-total removal of extensive plexiform neurofibromas with minimal morbidity while restoring lost function.

Patients with cleft lip or palate encounter a myriad of difficulties in their early years of life, some of which begin at birth. The defect often impairs suckling and deglutition in the neonate. It can hinder appropriate speech development and may impose undue social and psychological stresses. Surgical and orthodontic interventions are essential and prosthetic palatal appliances play an important role not only throughout the patient's treatment course, but also in the treatment of unfavorable surgical sequelae.

Background: Acellular porcine dermis has been used as a soft-tissue substitute in Europe since 1998 and in the United States since 2000. Processing renders the composite acellular, reducing antigenicity and crosslinking the dermal collagen. The purpose of this study was to determine the long-term histologic response of this material to the transfer into a subcutaneous soft-tissue location in an in vivo mouse model., Methods: A total of 24 mice (ICR strain) underwent an initial procedure transplanting a segment of acellular porcine dermis into a dorsal subcutaneous pocket. The implants were examined for qualitative characteristics including rigidity, migration, inflammation, and healing response. Composites of skin, subcutaneous tissue, implant, and underlying muscle were harvested for histologic evaluation. The specimens were analyzed for inflammatory response, degree, and character of tissue incorporation and degree of implant resorption., Results: One of the 24 animals studied experienced extrusion of the implant. The remaining 23 implants persisted within their respective hosts until the time the animals were killed. The volume and weight of all of the implants remained unchanged from the preoperative to postoperative measurements. Dystrophic calcification and bone formation was seen at 12 months., Conclusions: The results do not suggest characteristics optimal for implants used in soft-tissue augmentation for the purpose of aesthetics. The porcine dermis would appear from these results to be better suited for situations that require strength and permanence of the implant.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the different technical options available for repairing facial fractures. 2. Know which technical points facilitate performance of fixation of the facial skeleton by relatively inexperienced surgeons. 3. Have a basic understanding of the most common complications arising after facial fracture repair. 4. Have an understanding of how to avoid surgical complications following facial fracture repair., Background: The treatment of facial trauma is associated with a myriad of potential complications. This may be compounded by the relative lack of compliance seen in the patient population within an urban trauma center and by the requisite involvement of residents in this care., Methods: This study retrospectively evaluated 189 patients with a total of 294 separate fractures treated over a 3.5-year period., Results: The overall rate of complications was 7.8 percent., Conclusions: The experience at a high-volume level I trauma center with residents as the primary physicians has confirmed that facial trauma surgery may be undertaken with an acceptably low complication rate. Numerous technical factors were thought to be responsible for this, including the use of miniplates for treatment in the majority of mandibular fractures, overcorrection of orbital volume in fractures involving the globe, and the use of a transconjunctival incision with a lateral canthotomy for access to the lower eyelid structures.

Management algorithms for frontal sinus fractures vary widely. Appropriate treatment depends on an accurate diagnosis, focusing on the physical examination and data from computed tomography scans. One must pay particular attention to involvement of the nasofrontal duct and violation of the posterior table because it is from these injuries that so much of the morbidity relating to these fractures is incurred. In large part, in the most severe injuries, a successful outcome is contingent upon meticulous removal of all visible frontal sinus mucosa with occlusion of the nasofrontal duct if required.

Purpura fulminans associated with meningococcemia is a devastating disease in children. The tissue loss can be extensive and difficult to determine at the outset. The authors suggest a strategy to manage these wounds with the goal of preserving as much tissue and function as possible. At the present time, conservative therapy to the wounds appears to be the best course in the initial, critical phase, as long as no active local purulence is found. Debridement or amputation is performed when the nonviable tissue margins are delineated. Temporary coverage with allograft may be required; definitive coverage is accomplished when the local tissue perfusion has recovered. Future revisions are often necessary to improve these children's quality of life.