Spring-Assisted Surgery for Treatment of Sagittal Craniosynostosis.

ABSTRACT: Craniosynostosis (CSS), the premature fusion of calvarial sutures, most commonly involves the sagittal suture. Cranial vault remodeling (CVR) is a traditional method of CSS correction. Minimally invasive methods are becoming widely accepted, including spring-assisted surgery (SAS). The equipment required for SAS is minimal therefore adaptable to resource challenged health systems. This paper outlines the experience of SAS in Moldova.A retrospective study was performed for patients treated with SAS for sagittal CSS from 2011 to 2018 in Moldova. Perioperative data were recorded including age, length of surgery, blood loss, volume transfused and length of stay. Four patients had pre- and post-operative computed tomography (CT) scans which were used to calculate changes in cephalic index, normative cephalic index, and intracranial volume.Thirteen patients underwent SAS. Diagnoses were made clinically and confirmed with CT. Mean age at surgery was 4.0 months, and length of surgery 62.7 minutes. All but one patient received a blood transfusion, as is standard of practice in Moldova. The mean length of post-operative recovery in ICU was 30.9 hours. No complications required surgical revision. Springs were removed after 4 to 5 months. All patients had a subjective improvement in scaphocephaly. Based on the available CT scans, an increase in cephalic index (7.3%), normative cephalic index (11.8%), and intracranial volume (38.1%) was observed. One patient underwent SAS at 11 months and required cranioplasty for asymmetry at the time of spring removal.SAS is a safe and cost-effective method of CSS correction that can be utilized in countries with limited health system resources.

Managing Ulcers Associated with Pyoderma Gangrenosum with a Urinary Bladder Matrix and Negative-Pressure Wound Therapy.

Pyoderma gangrenosum (PG) is a rare disease that presents as painful ulcerations with inflammation and undermining at the borders. The ulcers can occur anywhere on the body but are most commonly seen on the lower extremities. The etiology of PG is unknown, and there are no definitive diagnostic criteria; PG is a diagnosis of exclusion, which can present serious delays in treatment.Patients should be treated with an interdisciplinary approach with aggressive immunosuppression, treatment of any comorbidities, maximization of nutrition status, reconstructive surgery for treatment of the wound, and physical therapy for deconditioning.This article presents a case study of one patient treated with a porcine urinary bladder matrix and negative-pressure wound therapy; this treatment combination provided pain relief, coverage of the wound, an acceptable aesthetic outcome, and long-term stability.