Regenerative matching axial vascularisation of absorbable 3D-printed scaffold for large bone defects: A first in human series

BackgroundWe describe the first clinical series of a novel bone replacement technique based on regenerative matching axial vascularisation (RMAV). This was used in four cases: a tibial defect after treatment of osteomyelitis; a calvarial defect after trauma and failed titanium cranioplasty; a paediatric tibial defect after neoadjuvant chemotherapy and resection of Ewing sarcoma; and a paediatric mandibular deficiency resulting from congenital hemifacial microsomia.MethodAll patients underwent reconstruction with three-dimensional (3D)-printed medical-grade polycaprolactone and tricalcium phosphate (mPCL-TCP) scaffolds wrapped in vascularised free corticoperiosteal flaps.OutcomeFunctional volumes of load-sharing regenerate bone have formed in all cases after a moderate duration of follow-up. At 36 cm, case 1 remains the longest segment of load bearing bone ever successfully reconstructed. This technique offers an alternative to existing methods of large volume bone defect reconstruction that may be safe, reliable, and give predictable outcomes in challenging situations. It achieves this by using a bioresorbable scaffold to support and direct the growth of regenerate bone, driven by RMAV.ConclusionThis technique may facilitate the reconstruction of bone defects previously thought unreconstructable, reduce the risk of long-term implant-related complications and achieve these outcomes in a hostile environment. These potential benefits must now be formally tested in prospective clinical trials.     

Infraorbital fat tissue volume and density changes in different age groups: Evaluation with computed tomography

ObjectivesWe investigated senile volume and density changes in infraorbital fat to evaluate by computed tomography (CT).MethodsCT examinations of a total of 120 patients (60 males and 60 females) were included in 3 age groups: 18–29 (group 1), 30–49 (group 2), and 50 years and older (group 3). Body weight and height and BMI were recorded, and infraorbital fat tissue volume and density were measured on CT.ResultsBody weight and BMI of ≥50 years of age were significantly higher than the younger ones. In overweight and obesity groups, infraorbital fat volume increased and density decreased compared to the underweight and normal weight groups. In ≥50 years of age group, infraorbital fat volume was higher; density was lower than 18–29 years of age. Female's infraorbital fat volume was higher; density was lower than males. In each age group, the infraorbital fatty tissue density of the females was significantly lower than those in the males. There was a negative correlation between infraorbital fat volume and density. In older patients and as age groups, body weight and BMI increased, infraorbital fat volume increased, and infraorbital fat density decreased.ConclusionBy aging, BMI and body weight and infraorbital fat volume increased, and infraorbital fat density decreased, especially at ≥50 years of age that is thought to be one of the factors that play a role in the downward bulging of infraorbital fat tissue. Females’ higher infraorbital fat volume and infraorbital fat density may be a reason for the females’ bulging in the infraorbital fat region.