Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint.

PURPOSE: The management of a proximal interphalangeal (PIP) joint fracture dislocation becomes more challenging when the joint surface is damaged because of severe comminution or inadequate treatment in the acute phase. The purpose of this study was to evaluate the clinical outcomes of an osteochondral autograft for the reconstruction of the joint surface in patients with a partial PIP joint defect. METHODS: Twelve patients underwent osteochondral autograft surgery from May 2007 to July 2018. The average age at the time of surgery was 38 years (range, 21-67 years), and there were 10 men and 2 women. Plain radiographs and computed tomography scans showed a partial middle phalangeal base defect in all the cases. The surgeries were performed 2 weeks to 20 months after the fracture or a previous surgery. Partial hamate grafts were harvested to reconstruct volar lip (n = 7), middle portion (n = 2), and dorsal lip (n = 3) defects of the middle phalangeal base. Bone healing, postoperative range of motion, instability, and pain were evaluated. The average follow-up duration was 27.8 months (range, 12-53 months). RESULTS: Radiographic graft union was observed in all the patients 6-8 weeks after the surgery. The deformity was corrected in 11 patients. The active range of motion of the involved PIP joint was improved from 28.3° (range, 0°-60°) to 75.0° (range, 25°-95°). Complications were observed during follow-up, including degenerative arthritis (n = 2), instability (n = 3), and stiffness (n = 5). CONCLUSIONS: Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate. The functional recovery is generally acceptable, with a well-restored joint architecture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

XFinger-Net: Pixel-Wise Segmentation Method for Partially Defective Fingerprint Based on Attention Gates and U-Net.

Partially defective fingerprint image (PDFI) with poor performance poses challenges to the automated fingerprint identification system (AFIS). To improve the quality and the performance rate of PDFI, it is essential to use accurate segmentation. Currently, most fingerprint image segmentations use methods with ridge orientation, ridge frequency, coherence, variance, local gradient, etc. This paper proposes a method of XFinger-Net for segmenting PDFIs. Based on U-Net, XFinger-Net inherits its characteristics. The attention gate with fewer parameters is used to replace the cascaded network, which can suppress uncorrelated regions of PDFIs. Moreover, the XFinger-Net implements a pixel-level segmentation and takes non-blocking fingerprint images as an input to preserve the global characteristics of PDFIs. The XFinger-Net can achieve a very good segmentation effect as demonstrated in the self-made fingerprint segmentation test.

Vertical Bone Augmentation Using Three-dimensionally Printed Cap in the Rat Calvarial Partial Defect.

BACKGROUND/AIM: Lost alveolar bone is commonly restored by distraction osteogenesis or bone blocks for substantial vertical bone augmentation (VBA), that is applied in conjunction with a barrier system. This study was performed to determine whether volume control of a three-dimensional (3D) printed nylon cap in the rat calvarial partial thickness bone defect would induce qualitative and quantitative differences in vertical bone regeneration. MATERIALS AND METHODS: A rat calvarial partial thickness bone defect was prepared and the 3D cap covered the defect to induce VBA, while the control group was left without cap placement. After six weeks the animals were sacrificed, and the calvaria were prepared for micro-CT (µCT) and histology. RESULTS: Quantitative µCT results showed that our cap system has significant osteoconductive properties, and the histology slide revealed new bone filled inside the cap. CONCLUSION: The results clearly showed that this system was successful for VBA in a research animal model.

Atrial Septal Defect Closure with Occlutech® ASD Fenestrated Device in a Child with Severe Pulmonary Hypertension.

We report a 5-year-old patient with severe pulmonary hypertension and a large secundum atrial septal defect who benefited from a percutaneous closure of the defect with an Occlutech® custom-made fenestrated device. Whereas the closure is technically identical to standard atrial defect closure, the immediate and midterm beneficial results are presented.

Congenital absence of the pericardium.

Congenital absence of the pericardium is a rare cardiac malformation and is most often asymptomatic. It is usually discovered as an incidental finding. Physical examination, chest radiography, and electrocardiogram are often unremarkable. Echocardiography provides valuable information, and sometimes computed tomography or magnetic resonance imaging is needed for subsequent confirmation.

Congenital Absence of the Pericardium

Congenital absence of the pericardium is a rare cardiac malformation and is most often asymptomatic. It is usually discovered as an incidental finding. Physical examination, chest radiography, and electrocardiogram are often unremarkable. Echocardiography provides valuable information, and sometimes computed tomography or magnetic resonance imaging is needed for subsequent confirmation.

Renal involvement in a patient with cobalamin A type (cblA) methylmalonic aciduria: a 42-year follow-up.

Chronic renal failure is a well-known long-term complication of methylmalonic aciduria (MMA-uria), occurring even under apparently optimal metabolic management. The onset of renal dysfunction seems to be dependent on the type of defect and vitamin B12-responsiveness. We report on a patient with a vitamin B12-responsive cobalamin A type (cblA) MMA-uria caused by a homozygous stop mutation (p.R145X) in the cobalamin A gene (MMAA). She was diagnosed with chronic kidney disease (CKD) stage III at the age of 12 years. Following re-evaluation, the patient received vitamin B12 (hydroxocobalamin) treatment, resulting in a significant decrease in the concentration of methylmalonic acid (MMA) in urine and plasma. Until age 29 years glomerular filtration rate remained stable probably due to hydroxocobalamin treatment slowing down progression to end-stage renal failure. Kidney biopsies showed non-specific manifestations of chronic interstitial inflammation. The patient received a renal transplant at age 35 years. Under continuous treatment with hydroxocobalamin there is no evidence of kidney damage due to MMA-uria until the last follow-up 6 years after transplantation. This case report illustrates (i) a long-term follow-up of a patient with MMA-uria due to cblA deficiency, (ii) the involvement of the kidney as a target organ and (iii) the importance of early and adequate vitamin B12 substitution in responsive patients. Further investigation will be necessary to prove the protective effect of hydroxocobalamin in the kidney in vitamin B12-responsive patients.

The experience for reconstructing calcaneus partial defect with deep iliac circumflex artery ilium lamella and sural nerve flap:7 cases report / 中华显微外科杂志

Objective To explore the surgical treatment effect reconstructing calcaneus partial defect with deep iliac circumflex artery illium lamella and sural nerve slap. Methods Sevens of calcaneus fracture with posterior part defect from July 2005 to July 2010 were rehabilitated with deep iliac circumflex artery ilium lamella whose artery were anastomosed to posterior tibial artery and whose skin were repaired with sural nerve slap. Results All patients were obtained follow-up,which ranged from 9 to 30 months with a mean of 19.5 months. Its Bohler angle maintain a range from 35 to 45 degree and foot bridge maintain its figure,as well as perfect skin.According to Maryland grades system,the result were excellent in 3 cases with score 90,good in 2 with score 85 and fair in 2 with score 75. Conclusion It is a perfect method for calcaneus trauma which lose its foot bridge to rehab its figure and function with deep iliac circumflex artery ilium lamella and sural nerve slap.

Reconstruction of penile partial defect with corpora cavernosa lengthening and pedicle skin flap transferring (report of 42 cases) / 中华泌尿外科杂志

Objective To investigate the reconstructive method with better sensory and erectile function for partial penile defect. Methods The procedure was as follows: dissecting the suspensory ligaments and separating part of crus,the local fat flap was transferred to fill the front space of symphysis ossium pubica.Various pedicle skin flaps were designed as covering materials.Penis residual stump was advanced to anterior portion of the newly reconstructed penile body as “glans”.The post-operative follow-up included taking full layer skin of penis from the patients to observe neurofibril regeneration by light microscope, electron microscope and scanning electron microscope;determining sensation recovery by physical examination;and checking erectile function with NEVA system. Results 42 patients underwent the above mentioned procedures.In these cases,the length of the penis varied from 0.5～4.0 cm in flaccid,1.5～5.0 cm in erect state before operation to 5.0～8.0 cm in flaccid,7.0～12.5 cm in erect state after operation.28 patients were followed up for more than 1 year.Of them 23 men got married with acceptable sexual activity;in them 18 had their children.The microscopic examination showed that the tenuous wavy peripheral nerves were well differentiated and no denaturation and necrosis were observed in the dermis,near subcutaneous adipose and around eccrine glands.The positive granules could be seen in the cytoplasm of regenerative neurofibrils by immunohistochemistry technique.The regenerative neurofibrils and related tissues could be seen under scanning and transmission electron microscope.The penis presented normal pain,touch feeling and 2-point identification ability in more than 12 months after surgery.Over 12 months after surgery,the patient had gained 4～9 events during 8～12 hours of sleep, and the durations were 4 to 37 min;the volume changes were from 114% to 505% over baseline. Conclusions With this method,the reconstructed penis tends to have better appearance and functions.For penile partial defect it is superior to the conventional operation.

Reconstruction of the Partial Soft Tissue Defect of the Nose

Reconstruction of total nasal defect is limited in methods, but in cases of partial nasal defect, various methods can be adapted according to the size, shape and location. The authors tried to summarize the relationship between the etiology, location, size of partial nasal defect and reconstructive methods. The authors experienced 27 patients of partial nasal defect for the recent 3 years, male patients were 13 and female patients were 14 among them. The age of the patients ranged from 27 to 78. Malignant skin tumor was the most common among the causes of the defect: 16 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma. The locations of the defect can be summarized as 8 cases of nasal alar area, 8 cases of nasal tip area, 6 cases of nasal side wall and 5 cases of nasal dorsum. As reconstructive methods, the authors used median forehead flap in 7 cases, dorsal nasal flap in 6 cases, full thickness skin graft in 5 cases, bilobed local flap in 3 cases, nasolabial flap in 3 cases, and other local flap in 3 cases. Skin graft is an easy method for the shallow defect, but its major disadvantage is color mismatch with adjacent skin. In cases of flap surgery, though it often causes deformity in contour, appropriate reconstruction was possible with through preoperative evaluation. According to our survey, local flap such as bilobed flap was enough for the defect of small size, and in cases moderate to large sized defect, nasolabial flap was appropriate for defect in nasal tip area, dorsal nasal flap was good for the defect in nasal dorsum and median forehead flap was useful for the defect in nasal side wall. The authors presents our comparative results of the 27 cases of partial nasal defect for the recent 3 years with the hope of being contributed in choosing the reconsfructive methods in the future.