Reconstructing complex peripatellar defects using the descending genicular artery perforator flap.

BACKGROUND: Complex peripatellar defects are commonly reconstructed with free flaps or pedicled muscle flaps, whereas pedicled fasciocutaneous perforator flaps are commonly overlooked. The descending genicular artery perforator (DGAP) flap is a versatile flap that offers thin and pliable tissue that provides ideal 'like with like' peripatellar soft tissue defect reconstruction. This paper aims to demonstrate the safe use of a pedicled fasciocutaneous DGAP flap for extensive traumatic peripatellar defect reconstructions and to exhibit the surgical pearls via a case series. METHODS: A retrospective cohort study of consecutive complex peripatellar reconstructions with DGAP flaps was conducted from January 2011 to December 2018. Patient demographics, medical comorbidities, aetiology/size/and location of the defects were reviewed. Flap, donor site, and overall surgical outcomes were clinically assessed and documented. Descriptive statistics were conducted and analysed by IBM SPSS Statistics 23. RESULTS: Five consecutive cases with complex peripatellar defects (5 × 8 to 8 × 10 cm) were recruited. Two were males, and three were females, with a mean age of 38.4 years. Four were trauma, and one was an oncological case. Descending genicular artery (DGA) perforators and DGA terminal branches were consistent. One patient needed a split-thickness skin graft to reconstruct the secondary defects. All the flaps survived with an average follow-up of 24 months. CONCLUSION: The DGAP flap provides a reliable alternative to free flap for the large, complex peripatellar defect. With the inclusion of the proximal long saphenous vein and judicious selection of DGA perforators and its terminal branches, the DGAP flap can be harvested and used safely in the high-velocity impacted knee.

Knowledge about cervical cancer early warning signs and symptoms, risk factors and vaccination among students at a medical school in Al-Ahsa, Kingdom of Saudi Arabia.

BACKGROUND: Cervical cancer is the second most common cancer among females and also the most preventable. In the literature there is abundant evidence that awareness regarding cervical cancer and its prevention is low in the developing countries. Medical students are the future health professionals and can play an important role in increasing awareness among the general population. To assess the knowledge regarding symptoms, risk factors and prevention of cervical carcinoma among medical students in th Kingdom of Saudi Arabia, the present study was planned. MATERIALS AND METHODS: This cross-sectional study was conducted using a self-administered questionnaire with students at the College of Medicine, King Faisal University, Al-Ahsa, KSA, from December 2012 to May 2013. RESULTS: The responses of 188 students (males 111, females 77) in their second, third, fourth, and fifth years were recorded and used in the data analysis. The majority of the students were not aware of the early warning signs, symptoms and risk factors. On average, only 43.7% males and 56% of females were aware about the early signs and symptoms whereas 51.4% males and 57.8% females had knowledge about the risk factors of cervical cancers. Some 55% males and 46.8% females were unable to select the correct answer regarding human papilloma virus (HPV) infection as the cause of cervical cancer. Majority of the students (67%) were not aware about the availability of vaccine against HPV. CONCLUSIONS: Lack of knowledge regarding early signs and symptoms, risk factors and prevention of cervical cancer was observed in the present study.

Fluorescence characteristics and inclusion of ICT fluorescent probe in organized assemblies.

The inclusion behavior of an intramolecular charge transfer (ICT) fluorescent probe namely; 2-[3-(4-dimethylamino-phenyl)-allylidene]-tetralone (DMAPT) in organized assemblies of aqueous micellar, α- and ß-cyclodextrins (CDs) and bovine serum albumin (BSA) pockets have been studied using steady-state absorption and fluorescence spectroscopy. The fluorescence characteristics (energy and intensity) of DMAPT are highly sensitive to the properties of the medium. The ICT maximum is strongly blue-shifted with a great enhancement of the fluorescence intensity upon addition of different surfactants, confirming the solubilization of DMAPT in the hydrophobic micellar assembly. In addition, the fluorescence of DMAPT is more sensitive to the nature and concentration of the added CDs. In α- or ß-CD solutions, the fluorescence intensity increases strongly (by 6 and 23 orders of magnitude, respectively). Upon encapsulation in the CD cavity, the molecular flexibility decreases due to the geometrical restrictions of the CD nanocavity which decreases the non radiative transition via the free rotation around the single and/or double bonds of the butadiene bridge. This was supported by finding that the fluorescence quantum yield of DMAPT increases with increasing the viscosity of the medium. The binding constants of DMAPT with micelles, α- and ß-CD solutions have been calculated and were found to be highly dependent on the nature of the used surfactants or CDs. The thermodynamic parameters have been also determined and the difference in magnitude between the formed α- and ß-CD-DMAPT inclusion complexes is discussed on the basis of the cavity size. Finally, the binding constant of DMAPT with bovine serum albumin was calculated, indicating the relative stability of the DMAPT-BSA complex. The energy transfer distance between BSA as a donor and DMAPT as an acceptor was obtained following the fluorescence quenching of BSA by DMAPT, via resonance mechanism as a quencher.

PixEye Virtual Reality Training has the Potential of Enhancing Proficiency of Laser Trabeculoplasty Performed by Medical Students: A Pilot Study.

OBJECTIVE: To compare the surgical proficiency of medical students who underwent traditional training or virtual reality training for argon laser trabeculoplasty with the PixEye simulator. MATERIALS AND METHODS: The cohort comprised of 47 fifth year male medical students from the College of Medicine, King Faisal University, Saudi Arabia. The cohort was divided into two groups: students (n = 24), who received virtual reality training (VR Group) and students (n = 23), who underwent traditional training (Control Group). After training, the students performed the trabeculoplasty procedure. All trainings were included concurrent power point presentations describing the details of the procedure. Evaluation of surgical performance was based on the following variables: missing the exact location with the laser, overtreatment, undertreatment and inadvertent laser shots to iris and cornea. RESULTS: The target was missed by 8% of the VR Group compared to 55% in the Control Group. Overtreatment and undertreatment was observed in 7% of the VR Group compared to 46% of the Control Group. Inadvertent laser application to the cornea or iris was performed by 4.5% of the VR Group compared to 34% of the Control Group. CONCLUSION: Virtual reality training on PixEye simulator may enhance the proficiency of medical students and limit possible surgical errors during laser trabeculoplasty. The authors have no financial interest in the material mentioned in this study.