Microtia Reconstruction: Our Strategies to Improve the Outcomes.

Introduction : Autologous costal cartilage framework placement is currently the gold standard in patients with microtia. In this article, we present the modifications developed by the author, generally following the principles established by Nagata, and discuss the technical details that have led us to achieve consistently stable and good long-term outcomes for auricular reconstruction in microtia. Materials and Methods : A retrospective review of microtia reconstruction performed from 2015 to 2021 was done. Those who underwent primary reconstruction for microtia and with a minimum follow-up of 6 months with documented photographs were included. Those who underwent secondary reconstruction for microtia and those who did not follow-up for a minimum period of 6 months were excluded. Outcomes were assessed with regard to appearance, and durability of the result. Influence of certain changes like delaying reconstruction until 15 years of age, use of nylon for framework fabrication, etc. over the outcome were assessed. Results : Of 11 ears reconstructed at less than 15 years of age, only one patient (9%) had a good long-term outcome, whereas of the 17 ears reconstructed at greater than 15 years of age, nine patients (53%) had a good long-term outcome. In our experience, infections and wire extrusions were the significant events related to severe cartilage resorption. Conclusion : In our experience, delaying the first stage to 15 years or later, using double-armed nylon sutures, and reducing the projection of the third layer of the framework in select cases have helped to improve our outcomes. Second stage of reconstruction can be avoided if patient is satisfied with the projection achieved in the first stage.

Biomedical image retrieval using adaptive neuro-fuzzy optimized classifier system.

The quantity of scientific images associated with patient care has increased markedly in recent years due to the rapid development of hospitals and research facilities. Every hospital generates more medical photographs, resulting in more than 10 GB of data per day being produced by a single image appliance. Software is used extensively to scan and locate diagnostic photographs to identify patient's precise information, which can be valuable for medical science research and advancement. An image recovery system is used to meet this need. This paper suggests an optimized classifier framework focused on a hybrid adaptive neuro-fuzzy approach to accomplish this goal. In the user query, similarity measurement, and the image content, fuzzy sets represent the vagueness that occurs in such data sets. The optimized classifying method 'hybrid adaptive neuro-fuzzy is enhanced with the improved cuckoo search optimization. Score values are determined by utilizing the linear discriminant analysis (LDA) of such classified images. The preliminary findings indicate that the proposed approach can be more reliable and effective at estimation than can existing approaches.

Indian Subcontinent's First Bilateral Supracondylar Level Upper Limb Transplantation.

Introduction This is the first case of supracondylar level transplant from the Indian subcontinent, performed for a bilateral below elbow amputee. It has a completely different set of challenges for the transplant team, with a relatively shorter ischemia time window. The technical considerations for the same have been discussed in detail in this article. Materials and Methods The patient was a 19-year-old female who lost her both upper limbs at proximal forearm level due to severe crush injury following a road traffic accident. Insufficient bone length on either side necessitated a supracondylar level transplant. The preoperative workup included detailed clinical evaluation, biochemical, and psychological evaluation. The donor was a young brain-dead, male patient from a hospital, 30 minutes away. The donor and recipient preparations in this case were unique. The recipient's own elbow flexors and extensors were used while the elbow joint was from the donor. The specific challenges we faced during this procedure have been described in detail. Results The transplantation has been a complete technical success, with the patient rehabilitated back to her independent life style. This article describes only the technical considerations. The functional recovery aspect is part of an another soon to be published manuscript. Conclusion Supracondylar level arm-transplant requires a highly coordinated team effort with precise preoperative planning, along with meticulous attention to detail to achieve a successful outcome. In properly selected patients, it could be a life-changing procedure, worth all the effort.

Injectable deferoxamine nanoparticles loaded chitosan-hyaluronic acid coacervate hydrogel for therapeutic angiogenesis.

In this study, an injectable chitosan-hyaluronic acid (CS-HA) based hydrogel was designed incorporating pro-angiogenic molecule, deferoxamine loaded PLGA nanoparticles (DFO NPs), for enhancing angiogenesis. DFO-NPs were prepared by double emulsion solvent diffusion technique and characterized for their physicochemical properties. The DLS and SEM analysis showed an average particle size of 220±71nm with spherical morphology and the encapsulation efficiency was found to be 30±5%. An ECM mimicking chitosan-hyaluronic acid (CS-HA) coacervate hydrogel was prepared. Both free DFO and DFO NPs were entrapped into the prepared CS-HA composite hydrogel. The hydrogels were characterized by SEM, FTIR and Rheology. Addition of DFO NPs did not affect the injectablility and flowability of developed hydrogels. In vitro DFO release from the prepared composite hydrogels showed controlled release over a period of 10days. Both the hydrogel systems showed excellent cyto-compatability and good cell proliferation for rASCs as well as HUVECs. The DFO and DFO NPs loaded composite hydrogels revealed effective tube formation in comparison with control hydrogels without DFO and DFO NPs. The in vivo angiogenic evaluation of the free DFO and DFO NPs (0.025%w/w) loaded composite hydrogels were studied by injecting the developed hydrogel subcutaneously into mice for 2-4 weeks. The DFO NPs loaded composite hydrogel had enhanced neovascularization when compared to control gels. Thus, the developed DFO NPs loaded composite hydrogel could potentially be used for therapeutic angiogenesis.