Reconstruction of Mandibular Defect by Free Re-Vascularized Fibula Graft: A Case Report

Background: In maxillofacial surgery tumor ablation often causes continuity defect of mandible which results anatomical and functional morbidity of the patient. The reconstruction of the mandibular defect is mandatory to restore the oral function and speech. Various methods of immediate reconstruction are implemented by different authors time to time including autogenous non vascularized bone graft, allogenic bone graft , auto frozen mandible or reconstruction plates and others. Each has its own advantages and disadvantages including donor site morbidity, failure and others. The purpose of the present case report is to establish micorvascular free fiblula is as a better option to other methods in immediate reconstruction of mandibular continuity defect. Objective: Anatomical, functional and esthetic rehabilitation of patients after mandibular resection Method: Revascularization of free fibula graft by microvascular anastomosis of paroneal artery with facial artery at the segmental defect site of mandible. Result: Remarkable contour, cosmesis and early functional rehabilatation of the patient. Conclusion: Microvascular reconstruction with fibula is the better option for defect correction and early rehabilitation in patients with mandibular continuity defect. Key words: Mandible, defect; reconstruction; microvascular technique; fibula graftDOI: 10.3329/bsmmuj.v1i1.3698 BSMMU J 2008; 1(1): 35-3

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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Not AvailableIron homeostasis was studied in two tropical indica rice cultivars viz. Sharbati (high Fe) and Lalat (low Fe) having contrasting grain Fe concentration. Plants were hydroponically grown with 5 concentrations of Fe (0.05, 2, 5, 15, 50 mg L−1) till maturity. The effect of incremental Fe treatment on the plant was followed by analyzing accumulation of ferritin protein, activities of aconitase enzyme, enzymes of anti-oxidative defense and accumulation of hydrogen peroxide and ascorbic acid. Plant growth was adversely affected beyond 15 mg L−1 of Fe supplementation and effects of Fe stress (both deficiency and excess) were more apparent on the high Fe containing cultivar Sharbati than the low Fe containing Lalat. Level of ferritin protein and aconitase activity increased up to 5 mg L−1 of Fe concentration. Lalat continued to synthesize ferritin protein at much higher Fe level than Sharbati and the cultivar also had higher activities of peroxidase, superoxide dismutase and glutathione reductase. It was concluded that the tolerance of Lalat to Fe stress was because of its higher intrinsic ability to scavenge free radicals of oxidative stress for possessing higher activity of antioxidative enzymes. This, together with its capacity to sequester theexcess Fe in ferritin protein over a wider range of Fe concentrations made it more tolerant to Fe stress.Not Availabl

Biomimetically synthesized polymer-hydroxyapatite sheet like nano-composite

Biomimetic internal architecture is proving valuable for multi-tissue and structural tissue interface engineering. A biomimetic method developed for the in situ synthesis of hydroxyapatite in poly (vinyl) alcohol, produces nanocomposites in the form of fabric-like sheets, when subjected to lyophilisation. The surface reactive hydroxyl groups of poly (vinyl) alcohol encourage site-specific coupling of hydroxyapatite. This results in improved mechanical properties, which may be better for biomedical applications when compared to a mere blend of the above two

Inferiorly Based Fasciocutaneous Flaps In Leg - Our Experience

Inferiorly based fasciocutaneous flaps have emerged as an ideal material for the defects in lower leg and foot. We have used this flap in eleven patients since 1986 through 1989. The flaps have proved to be reliable over difficult areas of ankle and foot, either multistaged distant flaps or free flaps are the other alternative. Here inferiorly based fasciocutaneous flaps offer a much simpler and safer answer

Poly(vinyl alcohol)–hydroxyapatite biomimetic scaffold for tissue regeneration

Hydroxyapatite–poly(vinyl alcohol) composite blocks were produced by freeze–thawing in situ synthesized hybrid suspension. Matrix mediated precipitation of hydroxyapatite particles in the polymer, controlled the particle size in nanometer range (< 100 nm) and hydrogelation induced an ordered three-dimensional assembly of the particles. Morphological and crystallographic characterization revealed the formation of a macro-porous hydroxyapatite–poly(vinyl alcohol) nanocomposite block. Initial results indicate compositional dependence of modulus of elasticity of the composite

Hydroxyapatite coating on stainless steel pre-coated with bovine serum albumin at ambient conditions

A biomimetic process for coating of nanosized hydroxyapatite on stainless steel, which capitalises the dual nature of the protein bovine serum albumin in both metal binding and a strong affinity for calcium ions, has been developed. The novelty of the process lies in pre-conditioning the metallic surface using the above protein prior to its mineralization with hydroxyapatite at ambient conditions. The microporous morphology of these coatings may provide favourable solubility and resorbability as desired by many orthopaedic and orthodontic applications

Feasibility of molecular testing in a multicenter study with geographical variation in India: Epidermal growth factor receptor mutation as a model molecular test

Context: Trends in epidermal growth factor receptor (EGFR) mutation based on ethnicity assist the initial selection of targeted therapy regimen. Reported incidence of EGFR mutation in Indian NSCLC patients is variable, ranging from 22% to 51.8%. Aim and Settings and Design: This multicenter, noninterventional study evaluated the prevalence of EGFR mutation in Indian NSCLC patients, its association with patients’ demographics, and for the first time used a central laboratory for molecular testing. Subjects and Methods: Tissue samples from 252 NSCLC patients were tested at a Central Laboratory at Tata Memorial Hospital. Statistical Analysis Used: Patient demographics, baseline characteristics including smoking status from routine examination were recorded in a single visit. Chi-square or Fisher's exact test was used for association of EGFR mutation status with gender, age, smoking status, and histological subtypes. Results: The prevalence of EGFR mutation in Indian NSCLC patients was 23.4%. Among these, 55.9% patients had mutations in exon 19, 39% in exon 21, and 1.7% in exon 18. The incidence of EGFR mutation was higher in females than males (32.5% vs. 18.9%, respectively), and in 30.6% patients that had never smoked, 26.3% smokers, and 5.8% former smokers. The mean duration of transportation of tissue samples to the central laboratory was 48 h with an average turnaround time of 5 days for molecular testing. Conclusions: Molecular testing at a central laboratory is a feasible option in India. Prevalence of EGFR mutation in Indian NSCLC patients was similar across western and southern centers in India. A statistically significant association between EGFR mutation and gender as well as the smoking status of the patients was observed. Majority of the patients had in-frame deletions in exon 19