BACKGROUND: Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to its insidious nature and potential for severe bone and soft tissue destruction. This systematic review and meta-analysis aims to review the literature on the treatment of chronic osteomyelitis in long bones and assess cure rates in single versus two-stage surgery.
METHODS: Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates.
RESULTS: The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases.
CONCLUSIONS: This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary.

The purpose of this study is to compare outcomes in patients undergoing buried and non-buried free flaps for breast reconstruction, in addition to evaluating the safety and reliability of venous flow couplers. A retrospective review was performed of all patients undergoing free flap breast reconstruction between 2013 and 2023. The primary outcomes were free flap failure, complications and the number of procedures required to complete the reconstructive journey. A total of 322 flaps were performed in 254 consecutive patients, with 47.5% (n = 153) being buried and 52.0% (n = 169) being non-buried reconstructions. The most common flap of choice being deep inferior epigastric artery perforator flaps (81.9%) followed by profunda artery perforator flaps (14.3%). There was no significant difference between the two groups in complications, including flap failure (buried 2.0% vs. non-buried 1.8% p = 0.902). There was a significant reduction in the number of procedures required to complete the reconstructive journey, with 52.2% (n = 59) of patients undergoing single-stage breast reconstruction in the buried group compared with only 25.5% (n = 36) in the non-buried group (p < 0.001). Two (0.6%) patients experienced a false negative in which the signal of the flow coupler was lost but the flap was perfused during re-exploration. No flap losses occurred without being identified in advance by a loss of audible venous flow signal. Buried free flap breast reconstruction is safe and requires fewer operations to complete patients\' reconstructive journey. Flow couplers are a safe and effective method of monitoring buried free flaps in breast reconstruction.

Proximal humerus fractures (PHFs) are a common type of fracture in adults. Although PHFs are common, bilateral presentation is extremely rare. Most PHFs are treated conservatively. In this report, we describe a 69-year-old right-hand-dominant male patient who was involved in a high-impact motor vehicle accident (MVA). The patient\'s upper limbs were in a fully extended position while he was holding the driving wheel, where he sustained a side impaction to the car by a hard object that caused bilateral four-part PHF with dislocation, which was confirmed on radiological investigations. The orthopedic surgery team believed that surgical treatment was necessary and ideal for these bilateral fracture dislocations, specifically bilateral reverse total shoulder arthroplasty (RTSA). This is due to multiple factors, including the risk of humeral head avascular necrosis (AVN), the patient\'s advanced age, low demand, poor bone stock, osteoporosis, and a non-fixable fracture pattern. The patient underwent a single-stage bilateral RTSA procedure, which was well tolerated. He was optimized postoperatively. The post-operative X-ray showed good and satisfactory implant positions and orientation. Functional assessment using the Constant-Murley Score (CMS) and Disabilities of the Arm, Shoulder and Hand (DASH) score were calculated at three-months follow-up (right-left: 50-60 and 41-14, respectively), at five-months follow-up (right-left: 34-66 and 38-14, respectively), and at eight-months follow-up (right-left: 40-68 and 24-7.5, respectively). Follow-up X-rays revealed good tuberosities healing, and no loosening or scapular notching. In addition, pain was assessed on a numerical rating scale (NRS), which demonstrated fast pain relief. Short-term follow-up with the patient demonstrated that he was satisfied with the surgery, especially the left side with a pain score on the NRS of one. We selected to share our experience of this complex case with our peers in the field of orthopedic surgery worldwide so that such a procedure could be implemented in similar cases to ensure satisfactory outcomes following bilateral four-part PHF with dislocation.

An inferiorly based nasolabial flap (NLF) is a versatile flap for various oral cavity defects. However, it generally necessitates a second stage procedure to release the base at 3 weeks following the initial surgery. Reconstruction for oral cavity defects can be done with the inferiorly based nasolabial flap as a single-stage procedure. In this retrospective clinical audit, we analyzed patients who underwent an inferiorly based NLF reconstruction for oral cavity defect from January 2016 to September 2021. We analyzed the various defects for which this flap was used along with the associated complications and the safety of performing this flap in terms of its flap-related complications and the histopathological features such as margins. Forty-four patients underwent this inferiorly based single-stage NLF. The median age of the patients in the cohort was 56 years, with the majority being men (n = 38, 86.4%). Buccal mucosa and lip were the most common sites of the primary. Twenty-nine patients were per primam and 15 were recurrent cancers. Most had T1 (n = 14, 31.8%) and T2 (n = 19, 43.2%) cancers. The median closest margin was 6 mm and the base was 7 mm. There were no flap losses; however, 6 patients had minor wound breakdown for which secondary suturing was needed. Single-stage NLF is a safe flap that could be considered in select patients for appropriate oral cavity defects.

This paper has the aim to report the status of the HYPLANE project to date. HYPLANE is a horizontal take-off and landing Mach 4.5 bizjet-size aerospaceplane conceived by Trans-Tech and University Federico II of Naples and under study within the industrial-academic ecosystem of the Campania Aerospace District (DAC). HYPLANE has the aim to offer very fast suborbital flight for space tourism, microgravity experimentation and training, and also shortening time to connect two distant airports within a door-to-door scenario. The concept is based on the access to stratospheric altitudes (30 km) for either point-to-point stratospheric or suborbital flights as safe as today\'s commercial air transportation, by integrating enhanced state-of-the-art aeronautical and space technologies. Essentially, HYPLANE is mostly based on already relatively high TRL technologies which guarantees a sufficiently short time to market. The low wing loading configuration and designed ability to manoeuvre along the flight trajectories at small angles of attack, allow HYPLANE to guarantee accelerations and load factors of the same order as those characterizing the present civil aviation aircraft (FAA/EASA specifications). Thanks to its technical features, it may operate from/to more than 5000 airports all over the world needing short runways to take-off and land, which for point-to-point business aviation is paramount. Furthermore, characteristics such as small dimension, configuration and high cruising altitude determine reduced noise in the airports surrounding and low sonic boom impact on ground. These conditions will further facilitate not only the development of the commercial use of such kind of transportation mean, but also its social acceptability.

UNASSIGNED: Interpolated flaps remain the mainstay of nasal reconstruction. In this regard Paramedian forehead flap has been combined and modified variously by different surgeons. However, still multiple stages are required to give shape to the nose and ensure that skin and cartilaginous vault of nose are aesthetically and functionally reconstructed. However, we describe a technique in which cartilage is reconstructed at the same stage as harvesting the flap without risk of vascular compromise.
UNASSIGNED: We describe a retrospective chart review of reconstructive nasal procedure in 2 stages with reconstruction in the first sitting itself using Paramedian forehead flap and ipsilateral septal perichrondium and septal cartilage in 4 patients of lower nasal vault deficiency between Jan 2018 to Dec 2018. The patients age ranged from 10 to 67 Years. 2 of the patients needed surgery due to dog bite injury 1 due to excision of basal cell carcinoma and another due to road traffic accident. The technique involved harvesting an ipsilateral paramedian forehead flap along with ipsilateral septal perichondrial flap anteriorly based and using septal cartilage to make the skeleton. The flap was divided after 3 weeks and thinned suitably.
UNASSIGNED: All the patients reported complete uptake of flap without any cartilage necrosis. Functionally none of the patient reported more nasal block than that seen preoperatively. The average NOSE VAS score remained 17.5 reported 1 month after the second stage.
UNASSIGNED: Planning is the key for appropriate and cosmetically feasible nasal con-struction. Emphasis must be given to nasal subunit being reconstructed and the choice of flap must be robust. Our forehead flap uses 2 stage design with septal flap to allow for cartilage reconstruction in situ. We utilized post op small vessel dilators along with BACTIGRAS dressings to prevent infection. Our technique in both cases allowed for a greater nasal airway and greater nasal valve suppor.t.

In this era of microvascular expertise, free flaps are the preferred option by reconstructive surgeons but has technical limitation in rural set up. Nasolabial flaps has been widely mentioned in literature for smaller defect reconstruction with minimal morbidity. It is a robust flap for soft tissue reconstruction in early stage lesion of oral cavity. We present a series of single stage oral cavity reconstruction using inferiorly based islanded nasolabial flaps in small to moderate soft tissue defects. This is a retrospective study which included biopsy proven 10 patients diagnosed with early stage oral cavity malignancy. All the patients underwent single stage islanded nasolabial flap for small to moderate oral defects. Follow up of all patients were recorded with respect to clinical photographs, mouth opening, tongue mobility, deglutition, speech and patient satisfaction. All operated patients had good functional outcome in terms of swallowing, speech and tongue mobility. All patients were satisfactory with the postoperative results. In early stage oral malignancy patients, this option justifies a reliable and cost effective approach. Inferiorly based islanded nasolabial flaps provides a single stage, safer, faster and reliable option for small to moderate oral cavity defects.

Infection is one of the most catastrophic complication following total knee arthroplasty (TKA) and represents the second most common cause of TKA failure. Treatment of a patient with periprosthetic joint infection (PJI) could require often costly and prolonged hospital stays, weeks or months of antibiotic therapy, and multiple surgical procedures. The best management is still highly debating, whereas many treatment options are available. These include suppressive antibiotics, arthroscopic irrigation and debridement, open debridement with insert exchange, single-stage reimplantation and two-stage reimplantation. The choice of the treatment depends on many variables, including integrity of implant, timing of the infection, host factors (age, health, immunologic status), virulence of the infecting organism and wishes of the patient. The aim of this review is to provide a comprehensive understaning of the different options for knee PJIs.

There has been increased interest in direct-to-implant (DTI) reconstruction in recent years. The goal of this study was to focus on the re-operation rate of DTI in comparison with two-stage tissue expander (TE) reconstruction.
In total, 165 consecutive patients (222 breasts) underwent skin sparing mastectomy and immediate implant-based reconstruction between January 2010 and December 2019. Patients were divided to TE procedure and DTI (42,180 breasts, respectively). Data collected included demographics, operative details and oncological medical treatment, complications classified according to Clavien-Dindo, capsular contracture Baker 3-4 and re-operation due to complication or due to patient\'s wish to improve aesthetic appearance.
There were significantly more prophylactic mastectomies and BRCA gene mutation in the DTI breast reconstruction group, and more smokers and diabetic patients in the TE group. No significant difference was found in the complication rates between the groups (DTI-26.1%, TE-40.5%). However, major complication and re-operation rate due to complications were significantly different ( DTI-16.7% and 10.6%, TE-26.2% and 31%, respectively, p= 0.035, p = 0.008). No significant differences were found in Clavien-Dindo stages between the groups except for Grade 3b. Re-operation due to desire for aesthetic improvement was significantly higher in the TE group (DTI-38%. TE-69%, p=0.0003).
DTI immediate breast reconstruction can provide a good alternative to the traditional two-stage TE/implant operation. Both patients and surgeons can be reassured that the majority of the cases are one-stage reconstruction.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

UNASSIGNED: For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first.
UNASSIGNED: The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N·m valgus and 5.0-N·m internal rotation load (simulated pivot shift) at 0°, 15°, and 30° of flexion; and (4) 5.0-N·m external rotation load at 0°, 15°, and 30° of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm-diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30° of flexion. A 9.5 mm-diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90° of flexion, was used for the PCL graft.
UNASSIGNED: There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90° of flexion (9.05 ± 3.05 and 5.87 ± 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30°, 60°, and 90° of flexion. At 15° of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not.
UNASSIGNED: There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30° and the PCL graft fixed at 90°.
UNASSIGNED: This study showed that there was no evidence to support the use of one tensioning sequence over the other in single-stage multiligament knee reconstruction.