Search results for: plastic surgery

Authors: Sónia Ribeiro, Diana Farinha, Elsa Pereira, Hélia Sales, Filipa Figueiredo, Rita Pontes, João Nunes

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Conventional plastic impacts on Planet, natural resources contamination, human health as well as animals are the most attractive environmental and health attention. The lack of treatment in the end-of-life (EOL) phase and uncontrolled discard allows plastic to be found everywhere in the world. Food waste is increasing significantly, with a final destination to landfills. To face these difficulties, new packaging solutions are needed with the objective of prolonging the shelf-life of products as well as equipment solutions for the development of the mentioned packaging. FLUI project thus presents relevance and innovation to reach a new level of knowledge and industrial development focused in Ecodesign. Industrial equipment field for the manufacture of new packaging solutions based on biodegradable plastics films to apply in the food sector. With lesser environmental impacts and new solutions that make it possible to prevent food waste, reduce the production e consequent poor disposal of plastic of fossil origin. It will be a paradigm shift at different levels, from industry to waste treatment stations, passing through commercial agents and consumers. It can be achieved through the life cycle assessment (LCA) and ecodesign of the products, which integrates the environmental concerns in the design of the product as well as through the entire life cycle. The FLUI project aims to build a piece of new bio-PLA extrusion equipment with the incorporation of bioactive extracts through the production of flexible mono- and multi-layer functional films (FLUI systems). The biofunctional and biodegradable films will prompt the extension of packaged products’ shelf-life, reduce food waste and contribute to reducing the consumption of non-degradable fossil plastics, as well as the use of raw material from renewable sources.

Keywords: food packing, bioplastics, ecodesign, circular economy

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Authors: Fatna Benmessaoud, Mohammed Cheikh, Vencent Velay, Vanessa Vidal, Farhad Rezai-Aria, Christine Boher

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Ti-6Al-4V titanium alloy is one of the most widely used materials in aeronautical and aerospace industries. Because of its high specific strength, good fatigue, and corrosion resistance, this alloy is very suitable for moderate temperature applications. At room temperature, Ti-6Al-4V mechanical behavior is generally controlled by the behavior of alpha phase (beta phase percent is less than 8%). The plastic strain of this phase notably based on crystallographic slip can be hindered by various obstacles and mechanisms (crystal lattice friction, sessile dislocations, strengthening by solute atoms and grain boundaries…). The grains aspect of alpha phase (its morphology and texture) and the nature of its crystallographic lattice (which is hexagonal compact) give to plastic strain heterogeneous, discontinuous and anisotropic characteristics at the local scale. The aim of this work is to develop a multi-scale model for Ti-6Al-4V mechanical behavior using crystal plasticity approach; this multi-scale model is used then to investigate grains size, dispersion of grains size, crystallographic texture and slip systems activation effects on Ti-6Al-4V mechanical behavior under monotone quasi-static loading. Nine representative elementary volume (REV) are built for taking into account the physical elements (grains size, dispersion and crystallographic) mentioned above, then boundary conditions of tension test are applied. Finally, simulation of the mechanical behavior of Ti-6Al-4V and study of slip systems activation in alpha phase is reported. The results show that the macroscopic mechanical behavior of Ti-6Al-4V is strongly linked to the active slip systems family (prismatic, basal or pyramidal). The crystallographic texture determines which family of slip systems can be activated; therefore it gives to the plastic strain a heterogeneous character thus an anisotropic macroscopic mechanical behavior of Ti-6Al-4V alloy modeled. The grains size influences also on mechanical proprieties of Ti-6Al-4V, especially on the yield stress; by decreasing of the grain size, the yield strength increases. Finally, the grains' distribution which characterizes the morphology aspect (homogeneous or heterogeneous) gives to the deformation fields distribution enough heterogeneity because the crystallographic slip is easier in large grains compared to small grains, which generates a localization of plastic deformation in certain areas and a concentration of stresses in others.

Keywords: multi-scale modeling, Ti-6Al-4V alloy, crystal plasticity, grains size, crystallographic texture

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Authors: Sundaresan Soundararajan, George Ezekiel Silvananthan, Chor Ngee Tan

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Introduction: Transforaminal Interbody Fusion (TLIF) has been adopted for many decades now, however, XLIF, still in relative infancy, has grown to be accepted as a new Minimally Invasive Surgery (MIS) option. There is a paucity of reports directly comparing lateral approach surgery to other MIS options such as TLIF in the treatment of lumbar degenerative disc diseases. Aims/Objectives: The objective of this study was to compare the efficacy and clinical outcomes between Minimally Invasive Transforaminal Interbody Fusion (TLIF) and Minimally Invasive Lateral Interbody Fusion (XLIF) in the treatment of patients with degenerative disc disease of the lumbar spine. Methods: A single center, retrospective cohort study involving a total of 38 patients undergoing surgical intervention between 2010 and 2013 for degenerative disc disease of lumbar spine at single L4/L5 level. 18 patients were treated with MIS TLIF, and 20 patients were treated with XLIF. Results: The XLIF group showed shorter duration of surgery compared to the TLIF group (176 mins vs. 208.3 mins, P = 0.03). Length of hospital stay was also significantly shorter in XLIF group (5.9 days vs. 9 days, p = 0.03). Intraoperative blood loss was favouring XLIF as 85% patients had blood loss less than 100cc compared to 58% in the TLIF group (P = 0.03). Radiologically, disc height was significantly improved post operatively in the XLIF group compared to the TLIF group (0.56mm vs. 0.39mm, P = 0.01). Foraminal height increment was also higher in the XLIF group (0.58mm vs. 0.45mm , P = 0.06). Clinically, back pain and leg pain improved in 85% of patients in the XLIF group and 78% in the TLIF group. Post op hip flexion weakness was more common in the XLIF group (40%) than in the TLIF group (0%). However, this weakness resolved within 6 months post operatively. There was one case of dural tear and surgical site infection in the TLIF group respectively and none in the XLIF group. Visual Analog Scale (VAS) score 6 months post operatively showed comparable reduction in both groups. TLIF group had Owsterty Disability Index (ODI) improvement on 67% while XLIF group showed improvement of 70% of its patients. Conclusions: Lateral approach surgery shows comparable clinical outcomes in resolution of back pain and radiculopathy to conventional MIS techniques such as TLIF. With significantly shorter duration of surgical time, minimal blood loss and shorter hospital stay, XLIF seems to be a reasonable MIS option compared to other MIS techniques in treating degenerative lumbar disc diseases.

Keywords: extreme lateral interbody fusion, lateral approach, minimally invasive, XLIF

Procedia PDF Downloads 190

Authors: A. Ghasemipanah, R. Ziaie Moayed, H. Niroumand

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Improving the geotechnical properties of soil has always been one of the issues in geotechnical engineering. Traditional materials have been used to improve and stabilize soils to date, each with its own advantages and disadvantages. Although the soil stabilization by adding materials such as cement, lime, bitumen, etc. is one of the effective methods to improve the geotechnical properties of soil, but nanoparticles are one of the newest additives which can improve the loose soils. This research is intended to study the effect of adding nanobentonite on soil engineering properties, especially the unconfined compression strength and maximum dry unit weight, using clayey soil with low liquid limit (CL) from Kerman (Iran). Nanobentonite was mixed with soil in three different percentages (i.e. 3, 5, 7% by weight of the parent soil) with different curing time (1, 7 and 28 days). The unconfined compression strength, liquid and plastic limits and plasticity index of treated specimens were measured by unconfined compression and Atterberg limits test. It was found that increase in nanobentonite content resulted in increase in the unconfined compression strength, liquid and plastic limits of the clayey soil and reduce in plasticity index.

Keywords: nanobentonite particles, clayey soil, unconfined compression stress, soil improvement.

Procedia PDF Downloads 103

Authors: Yeraldin Galindo, Soraida Mora

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Solid urban waste represents one of the largest sources of global environmental pollution due to the large quantities of these that are produced every day; thus, the elimination of such waste is a major problem for the environmental authorities who must look for alternatives to reduce the volume of waste with the possibility of obtaining an energy recovery. At the Autónoma de Colombia University, approximately 423.27 kg/d of solid waste are generated mainly paper, cardboard, and plastic. A large amount of these solid wastes has as final disposition the sanitary landfill of the city, wasting the energy potential that these could have, this, added to the emissions generated by the collection and transport of the same, has as consequence the increase of atmospheric pollutants. One of the alternative process used in the last years to generate electrical energy from solid waste such as paper, cardboard, plastic and, mainly, organic waste or biomass to replace the use of fossil fuels is the gasification. This is a thermal conversion process of biomass. The objective of it is to generate a combustible gas as the result of a series of chemical reactions propitiated by the addition of heat and the reaction agents. This project was developed with the intention of giving an energetic use to the waste (paper, cardboard, and plastic) produced inside the university, using them to generate a synthesis gas with a gasifier prototype. The gas produced was evaluated to determine their benefits in terms of electricity generation or raw material for the chemical industry. In this process, air was used as gasifying agent. The characterization of the synthesis gas was carried out by a gas chromatography carried out by the Chemical Engineering Laboratory of the National University of Colombia. Taking into account the results obtained, it was concluded that the gas generated is of acceptable quality in terms of the concentration of its components, but it is a gas of low calorific value. For this reason, the syngas generated in this project is not viable for the production of electrical energy but for the production of methanol transformed by the Fischer-Tropsch cycle.

Keywords: alternative energies, gasification, gasifying agent, solid urban waste, syngas

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Authors: Omid Tavakol, Mahnaz Gholami

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Introduction : In this oral presentation the main goal is discussing immediate loading in dental implants , from treatment planning and surgical guide designing to delivery , follow up and occlusal consideration . Methods and materials : first of all systematic reviews about immediate loading will be considered . besides , a comparison will be made between immediate loading and conventional loading in terms of success rate and complications . After that different methods , prosthetic options and materials best used in immediate loading will be explained. Particularly multi unit abutments and their mechanism of function will be explained .Digital impressions and designing the temporaries is the next topic we are to explicate .Next issue is the differences between single unit , multiple unit and full arch implantation in immediate loading .Following we are going to describe methods for tissue engineering and papilla formation after extraction . Last slides are about a full mouth rehabilitation via immediate loading technique from surgical designing to follow up .At the end we would talk about potential complications , how to prevent from occurrence and what to do if we face up with .

Keywords: guided surgery, digital implantology, immediate loading, digital dentistry

Procedia PDF Downloads 24

Authors: Fumihiro Ima, Shinichi Watanabe, Shingo Maeda, Haruna Imai, Hiroki Niimi

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It is important to know growth rate of brain tumors before surgery because it influences treatment planning including not only surgical resection strategy but also adjuvant therapy after surgery. Amide proton transfer (APT) imaging is an emerging molecular magnetic resonance imaging (MRI) technique based on chemical exchange saturation transfer without administration of contrast medium. The underlying assumption in APT imaging of tumors is that there is a close relationship between the proliferative activity of the tumor and mobile protein synthesis. We aimed to evaluate the diagnostic performance of APT imaging of pre-and post-treatment brain tumors. Ten patients with brain tumor underwent conventional and APT-weighted sequences on a 3.0 Tesla MRI before clinical intervention. The maximum and the minimum APT-weighted signals (APTWmax and APTWmin) in each solid tumor region were obtained and compared before and after clinical intervention. All surgical specimens were examined for histopathological diagnosis. Eight of ten patients underwent adjuvant therapy after surgery. Histopathological diagnosis was glioma in 7 patients (WHO grade 2 in 2 patients, WHO grade 3 in 3 patients and WHO grade 4 in 2 patients), meningioma WHO grade1 in 2 patients and primary lymphoma of the brain in 1 patient. High-grade gliomas showed significantly higher APTW-signals than that in low-grade gliomas. APTWmax in one huge parasagittal meningioma infiltrating into the skull bone was higher than that in glioma WHO grade 4. On the other hand, APTWmax in another convexity meningioma was the same as that in glioma WHO grade 3. Diagnosis of primary lymphoma of the brain was possible with APT imaging before pathological confirmation. APTW-signals in residual tumors decreased dramatically within one year after adjuvant therapy in all patients. APT imaging demonstrated excellent diagnostic performance for the planning of surgery and adjuvant therapy of brain tumors.

Keywords: amides, magnetic resonance imaging, brain tumors, cell proliferation

Procedia PDF Downloads 120

Authors: Fumihiro Imai, Shinichi Watanabe, Shingo Maeda, Haruna Imai, Hiroki Niimi

Abstract:

It is important to know the growth rate of brain tumors before surgery because it influences treatment planning, including not only surgical resection strategy but also adjuvant therapy after surgery. Amide proton transfer (APT) imaging is an emerging molecular magnetic resonance imaging (MRI) technique based on chemical exchange saturation transfer without the administration of a contrast medium. The underlying assumption in APT imaging of tumors is that there is a close relationship between the proliferative activity of the tumor and mobile protein synthesis. We aimed to evaluate the diagnostic performance of APT imaging of pre-and post-treatment brain tumors. Ten patients with brain tumor underwent conventional and APT-weighted sequences on a 3.0 Tesla MRI before clinical intervention. The maximum and the minimum APT-weighted signals (APTWmax and APTWmin) in each solid tumor region were obtained and compared before and after a clinical intervention. All surgical specimens were examined for histopathological diagnosis. Eight of ten patients underwent adjuvant therapy after surgery. Histopathological diagnosis was glioma in 7 patients (WHO grade 2 in 2 patients, WHO grade 3 in 3 patients, and WHO grade 4 in 2 patients), meningioma WHO grade 1 in 2 patients, and primary lymphoma of the brain in 1 patient. High-grade gliomas showed significantly higher APTW signals than that low-grade gliomas. APTWmax in one huge parasagittal meningioma infiltrating into the skull bone was higher than that in glioma WHO grade 4. On the other hand, APTWmax in another convexity meningioma was the same as that in glioma WHO grade 3. Diagnosis of primary lymphoma of the brain was possible with APT imaging before pathological confirmation. APTW signals in residual tumors decreased dramatically within one year after adjuvant therapy in all patients. APT imaging demonstrated excellent diagnostic performance for the planning of surgery and adjuvant therapy of brain tumors.

Keywords: amides, magnetic resonance imaging, brain tumors, cell proliferation

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Authors: Petri Kouvo, Aino Kainulainen, Kimmo Koivunen

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Separate collection system for recyclable wastes in the Helsinki region was ranked second best of European capitals. The collection system includes paper, cardboard, glass, metals and biowaste. Residual waste is collected and used in energy production. The collection system excluding paper is managed by the Helsinki Region Environmental Services HSY, a public organization owned by four municipalities (Helsinki, Espoo, Kauniainen and Vantaa). Paper collection is handled by the producer responsibility scheme. The efficiency of the collection system in the Helsinki region relies on a good coverage of door-to-door-collection. All properties with 10 or more dwelling units are required to source separate biowaste and cardboard. This covers about 75% of the population of the area. The obligation is extended to glass and metal in properties with 20 or more dwelling units. Other success factors include public awareness campaigns and a fee system that encourages recycling. As a result of waste management regulations for source separation of recyclables and biowaste, nearly 50 percent of recycling rate of household waste has been reached. For households and small and medium size enterprises, there is a sorting station fleet of five stations available. More than 50 percent of wastes received at sorting stations is utilized as material. The separate collection of plastic packaging in Finland will begin in 2016 within the producer responsibility scheme. HSY started supplementing the national bring point system with door-to-door-collection and pilot operations will begin in spring 2016. The result of plastic packages pilot project has been encouraging. Until the end of 2016, over 3500 apartment buildings have been joined the piloting, and more than 1800 tons of plastic packages have been collected separately. In the summer 2015 a novel partial flow digestion process combining digestion and tunnel composting was adopted for source separated household and commercial biowaste management. The product gas form digestion process is converted in to heat and electricity in piston engine and organic Rankine cycle process with very high overall efficiency. This paper describes the efficient collection system and discusses key success factors as well as main obstacles and lessons learned as well as the partial flow process for biowaste management.

Keywords: biowaste, HSY, MSW, plastic packages, recycling, separate collection

Procedia PDF Downloads 194

Authors: Manjari Rai

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Urbanization is an inevitable process of development of human society and an outcome of economic development and scientific and technological progress. While urbanization process in promoting the development of human civilization, also no doubt, urban landscape has been a corresponding impact. Urban environment has suffered unprecedented damage majorly due to the increase in urban population density and heavy migration rate, traffic congestion, and environmental pollution. All this have however led to a major ecological degradation and imbalance. As lands are used for the rapid and unplanned urbanization, the green lands are diminished, and severe pollution is created by waste products. Plastic, the most alarming waste at landfill sites, is yet uncontrolled. Therefore, initiatives must be taken to reduce plastic mediated pollution and increase green application. However, increasing green land is not possible due to the landfill by urban structures. In order to create a harmonious environment, sustainable development in the urban landscape becomes a matter of prime focus. This paper thus discusses the concept of ecological design combined with the urban landscape design, green landscape design on urban structures and sustainable development through the use of recyclable waste materials which is also a low costing approach of urban landscape design.

Keywords: ecological, degradation sustainable, landscape, urban

Procedia PDF Downloads 393

Authors: Chana Pavneet

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Background: In more recent years in dentistry, a greater emphasis has been placed on competency-based education (CBE) programmes. Undergraduate and postgraduate curriculums have been reformed to reflect these changes, and adopting a CBE approach has shown to be beneficial to trainees and places an emphasis on continuous lifelong learning. The literature is vast; however, very little work has been done specifically to the assessment of competence in dentistry and even less so in oral surgery. The majority of the literature tends to opinion pieces. Some small-scale studies have been undertaken in this area researching assessment tools which can be used to assess competence in oral surgery. However, there is a lack of general consensus on the preferable assessment methods. The aim of this review is to identify the assessment methods available and their usefulness. Methods: Electronic databases (Medline, Embase, and the Cochrane Database of systematic reviews) were searched. PRISMA guidelines were followed to identify relevant papers. Abstracts of studies were reviewed, and if they met the inclusion criteria, they were included in the review. Papers were reviewed against the critical appraisal skills programme (CASP) checklist and medical education research quality instrument (MERQSI) to assess their quality and identify any bias in a systematic manner. The validity and reliability of each assessment method or tool were assessed. Results: A number of assessment methods were identified, including self-assessment, peer assessment, and direct observation of skills by someone senior. Senior assessment tended to be the preferred method, followed by self-assessment and, finally, peer assessment. The level of training was shown to affect the preferred assessment method, with one study finding peer assessment more useful in postgraduate trainees as opposed to undergraduate trainees. Numerous tools for assessment were identified, including a checklist scale and a global rating scale. Both had their strengths and weaknesses, but the evidence was more favourable for global rating scales in terms of reliability, applicability to more clinical situations, and easier to use for examiners. Studies also looked into trainees’ opinions on assessment tools. Logbooks were not found to be significant in measuring the competence of trainees. Conclusion: There is limited literature exploring the methods and tools which assess the competence of oral surgery trainees. Current evidence shows that the most favourable assessment method and tool may differ depending on the stage of training. More research is required in this area to streamline assessment methods and tools.

Keywords: competence, oral surgery, assessment, trainees, education

Procedia PDF Downloads 115

Authors: Nuha Alamro

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Besides achieving of weight loss, Bariatric surgery (BS) shown metabolic improvement including reduction of cardiovascular disease, insulin resistance and diabetes. This study aimed to measure BS effects on Framingham Risk Score (FRS) and metabolic syndrome (MetS) among patients who underwent BS. Additionally, to determine the effect of BS on TSH among euthyroid obese patients. A Retrospective follow-up study was conducted in King Abdullah Medical City. A total of 160 participants who underwent BS and completed one year of follow ups. Medical history, biochemical, anthropometric, and hormonal parameters were evaluated at baseline and 3-12 months after BS. International Diabetes Federation (IDF) criteria were used to diagnose MetS pre and postoperative. The mean age of participants was 41.9 ± 10.6 with Body Mass Index (BMI) of 48.8 ± 7.3. After 3 months, Systolic, Diastolic blood pressure (SBP, DBP), glycated haemoglobin (HBA1C), Low-density lipoprotein (LDL), cholesterol, triglycerides and Thyroid stimulating hormone (TSH) were significantly decrease (P < 0.001). Significant decrease was seen in Mets, BMI, FRS, SBP, DBP, HBA1C, LDL, triglycerides, cholesterol, liver enzyme, with significant increase in high-density lipoprotein (HDL) level 12 months post-op (P < 0.001). After 1 year, the prevalence of MetS, DM, HTN, FRS were significantly decrease from 72.5%, 43.1%, 78.1%, 11.4 to 16.3%, 9.4%, 22.5% and 5.4, respectively. Besides achieving substantial weight loss, MetS resolution was linked to improvement in cardiovascular risk profile.

Keywords: bariatric surgery, cardiovascular disease, metabolic syndrome, thyroid stimulating hormone

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Authors: R. Pardo, P. Menendez, MA Gil-Olarte, S. Sanchez, E. García, R. Quintana, J. Martín

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Introduction : Within oncoplastic breast techniques there is increased interest in immediate partial breast reconstruction. The volume resected is greater than that of conventional conservative techniques. Central tumours of the breast have classically been treated with a mastectomy with regard to oncological safety and cosmetic secondary effects after wide central resection of the nipple and breast tissue beneath. Oncological results for central quadrantectomy have a recurrence level, disease- free period and survival identical to mastectomy. Grissoti flap is an oncoplastic surgical technique that allows the surgeon to perform a safe central quadrantectomy with excellent cosmetic results. Material and methods: The Grissoti flap is a glandular cutaneous advancement rotation flap that can fill the defect in the central portion of the excised breast. If the inferior border is affected by tumour and further surgery is decided upon at the Multidisciplinary Team Meeting, it will be necessary to perform a mastectomy. All patients with a Grisotti flap undergoing surgery since 2009 were reviewed obtaining the following data: age, hystopathological diagnosis, size, operating time, volume of tissue resected, postoperative admission time, re-excisions due to positive margins affected by tumour, wound dehiscence, complications and recurrence. Analysis and results of sentinel node biopsy were also obtained. Results: 12 patients underwent surgery between 2009-2015. The mean age was 54 years (34-67) . All had a preoperative diagnosis of ductal infiltrative carcinoma of less than 2 cm,. Diagnosis was made with Ultrasound, Mamography or both . Magnetic resonance was used in 5 cases. No patients had preoperative positive axilla after ultrasound exploration. Mean operating time was 104 minutes (84-130). Postoperative stay was 24 hours. Mean volume resected was 159 cc (70-286). In one patient the surgical border was affected by tumour and a further procedure with resection of the affected border was performed as ambulatory surgery. The sentinel node biopsy was positive for micrometastasis in only two cases. In one case lymphadenectomy was performed in 2009. In the other, treated in 2015, no lymphadenectomy was performed as the patient had a favourable histopathological prognosis and the multidisciplinary team meeting agreed that lymphadenectomy was not required. No recurrence has been diagnosed in any of the patients who underwent surgery and they are all disease free at present. Conclusions: Conservative surgery for retroareolar central tumours of the breast results in good local control of the disease with free surgical borders, including resection of the nipple areola complex and pectoral major muscle fascia. Reconstructive surgery with the inferior Grissoti flap adequately fills the defect after central quadrantectomy with creation of a new cutaneous disc where a new nipple areola complex is reconstructed with a local flap or micropigmentation. This avoids the need for contralateral symmetrization. Sentinel Node biopsy can be performed without added morbidity. When feasible, the Grissoti flap will avoid skin-sparing mastectomy for central breast tumours that will require the use of an expander, prosthesis or myocutaneous flap, with all the complications of a more complex operation.

Keywords: Grisotti flap, oncoplastic surgery, central tumours, breast

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Authors: Bambang Piscesa, Mario M. Attard, Dwi Presetya, Ali K. Samani

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A numerical strategy formulated using a plasticity approach is presented to model spalling of the concrete cover in reinforced concrete columns. The stage at which the concrete cover within reinforced concrete column spalls has a direct bearing on the load capacity. The concrete cover can prematurely spall before the full cross-section can be utilized if the concrete is very brittle under compression such as for very high strength concretes. If the confinement to the core is high enough, the column can achieve a higher peak load by utilizing the core. A numerical strategy is presented to model spalling of the concrete cover. Various numerical strategies are employed to model the behavior of reinforced concrete columns which include: (1) adjusting the material properties to incorporate restrained shrinkage; (2) modifying the plastic dilation rate in the presence of the tensile pressure; (3) adding a tension cut-off failure surface and (4) giving the concrete cover region and the column core different material properties. Numerical comparisons against experimental results are carried out that shown excellent agreement with the experimental results and justify the use of the proposed strategies to predict the axial load capacity of reinforce concrete columns.

Keywords: spalling, concrete, plastic dilation, reinforced concrete columns

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Authors: Leo Laine, Morgan Johansson

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To meet the civilizations future needs for safe living and low environmental footprint, the engineers designing the complex systems of tomorrow will need efficient ways to model and optimize these systems for their intended purpose. For example, a civil defence shelter and its subsystem components needs to withstand, e.g. airblast and ground shock from decided design level explosion which detonates with a certain distance from the structure. In addition, the complex civil defence shelter needs to have functioning air filter systems to protect from toxic gases and provide clean air, clean water, heat, and electricity needs to also be available through shock and vibration safe fixtures and connections. Similar complex building systems can be found in any concentrated living or office area. In this paper, the authors use a multidomain modelling language called Modelica to model a concrete wall as a single degree of freedom (SDOF) system with elastoplastic properties with the implemented option of plastic hardening. The elastoplastic model was developed and implemented in the open source tool OpenModelica. The simulation model was tested on the case with a transient equivalent reflected pressure time history representing an airblast from 100 kg TNT detonating 15 meters from the wall. The concrete wall is approximately regarded as a concrete strip of 1.0 m width. This load represents a realistic threat on any building in a city like area. The OpenModelica model results were compared with an Excel implementation of a SDOF model with an elastic-plastic spring using simple fixed timestep central difference solver. The structural displacement results agreed very well with each other when it comes to plastic displacement magnitude, elastic oscillation displacement, and response times.

Keywords: airblast from explosives, elastoplastic spring model, Modelica modelling language, SDOF, structural response of concrete structure

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Authors: Katie-Beth Webster

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Mucormycosis is a rare opportunistic fungal infection that, if left untreated, can cause large scale tissue necrosis and death. There are a number of cases of this in the literature, most commonly in the head and neck region arising from sinuses. It is also usually found in immunocompromised patient subgroups. This study reviewed a number of cases of mucormycosis in previously fit and healthy young trauma patients to assess predisposing factors for infection and adequacy of current treatment paradigms. These trauma patients likely contracted the fungal infection from the soil at the site of the incident. Despite early washout and debridement of the wounds at the scene of the injury and on arrival in hospital, both these patients contracted mucormycosis. It was suspected that inadequate early debridement of soil contaminated limbs was one of the major factors that can lead to catastrophic tissue necrosis. In both cases, this resulted in the patients having a higher level of amputation than would have initially been required based on the level of their injury. This was secondary to cutaneous and soft tissue necrosis secondary to the fungal infiltration leading to osteomyelitis and systemic sepsis. In the literature, it appears diagnosis is often protracted in this condition secondary to inadequate early treatment and long processing times for fungal cultures. If fungal cultures were sent at the time of first assessment and adequate debridements are performed aggressively early, it could lead to these critically unwell trauma patients receiving appropriate antifungal and surgical treatment earlier in their episode of care. This is likely to improve long term outcomes for these patients.

Keywords: mucormycosis, plastic surgery, osteomyelitis, trauma

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Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: I. A Tijani, Y. F Wu, C.W. Lim

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Concrete Damaged Plasticity Model (CDPM) is capable of modeling the stress-strain behavior of confined concrete. Nevertheless, the accuracy of the model largely depends on its parameters. To date, most research works mainly focus on the identification and modification of the parameters for fiber reinforced polymer (FRP) confined concrete prior to damage. And, it has been established that the FRP-strengthened concrete behaves differently to FRP-repaired concrete. This paper presents a modified plastic damage model within the context of the CDPM in ABAQUS for modelling of a uniformly FRP-confined repaired concrete under monotonic loading. The proposed model includes infliction damage, elastic stiffness, yield criterion and strain hardening rule. The distinct feature of damaged concrete is elastic stiffness reduction; this is included in the model. Meanwhile, the test results were obtained from a physical testing of repaired concrete. The dilation model is expressed as a function of the lateral stiffness of the FRP-jacket. The finite element predictions are shown to be in close agreement with the obtained test results of the repaired concrete. It was observed from the study that with necessary modifications, finite element method is capable of modeling FRP-repaired concrete structures.

Keywords: Concrete, FRP, Damage, Repairing, Plasticity, and Finite element method

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Authors: Diane Ghanem, Oscar Covarrubias, Michael Raad, Dawn LaPorte, Babar Shafiq

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Introduction: Standardized exams have long been considered a cornerstone in measuring cognitive competency and academic achievement. Their fixed nature and predetermined scoring methods offer a consistent yardstick for gauging intellectual acumen across diverse demographics. Consequently, the performance of artificial intelligence (AI) in this context presents a rich, yet unexplored terrain for quantifying AI's understanding of complex cognitive tasks and simulating human-like problem-solving skills. Publicly available AI language models such as ChatGPT have demonstrated utility in text generation and even problem-solving when provided with clear instructions. Amidst this transformative shift, the aim of this study is to assess ChatGPT’s performance on the orthopaedic surgery in-training examination (OITE). Methods: All 213 OITE 2021 web-based questions were retrieved from the AAOS-ResStudy website. Two independent reviewers copied and pasted the questions and response options into ChatGPT Plus (version 4.0) and recorded the generated answers. All media-containing questions were flagged and carefully examined. Twelve OITE media-containing questions that relied purely on images (clinical pictures, radiographs, MRIs, CT scans) and could not be rationalized from the clinical presentation were excluded. Cohen’s Kappa coefficient was used to examine the agreement of ChatGPT-generated responses between reviewers. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT Plus. The 2021 norm table was used to compare ChatGPT Plus’ performance on the OITE to national orthopaedic surgery residents in that same year. Results: A total of 201 were evaluated by ChatGPT Plus. Excellent agreement was observed between raters for the 201 ChatGPT-generated responses, with a Cohen’s Kappa coefficient of 0.947. 45.8% (92/201) were media-containing questions. ChatGPT had an average overall score of 61.2% (123/201). Its score was 64.2% (70/109) on non-media questions. When compared to the performance of all national orthopaedic surgery residents in 2021, ChatGPT Plus performed at the level of an average PGY3. Discussion: ChatGPT Plus is able to pass the OITE with a satisfactory overall score of 61.2%, ranking at the level of third-year orthopaedic surgery residents. More importantly, it provided logical reasoning and justifications that may help residents grasp evidence-based information and improve their understanding of OITE cases and general orthopaedic principles. With further improvements, AI language models, such as ChatGPT, may become valuable interactive learning tools in resident education, although further studies are still needed to examine their efficacy and impact on long-term learning and OITE/ABOS performance.

Keywords: artificial intelligence, ChatGPT, orthopaedic in-training examination, OITE, orthopedic surgery, standardized testing

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Authors: Ritesh Verma, Manisha Rathi, Chand Singh Dhull, Sumit Sachdeva, Jitender Phogat

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Temporal trabeculectomy with the Ologen implant was done in a 66-year-old lady with uveitic glaucoma. Serial IOP measurement was done to assess the efficacy of ologen implant in uveitic glaucoma. The patient had an IOP of 4mmhg day 1 postoperatively and Ologen implant was in place with a well-formed bleb. On follow up patient had an IOP of 14mmhg and unaided visual acuity of 6/12 on day 10 postoperatively. After 12 weeks of Trabeculectomy with Ologen implant, the IOP of the patient was 14 mmHg, the vision was 6/6 with -1.25 DS and -1.25 DC at 90 degrees. Trabeculectomy performed in patients with uveitic glaucoma has a higher chance of failure due to increased inflammation and fibrosis. Trabeculectomy with ologen implant done in a patient of uveitic glaucoma provides excellent postoperative results and the patient has a well-controlled IOP even after 56 weeks of surgery and a best corrected visual acuity of 6/6. Trabeculectomy with the ologen implant is superior to other surgeries in cases of secondary glaucoma with increased inflammation.

Keywords: glaucoma surgery, ologen implant, temporal trabeculectomy, uveitic glaucoma

Procedia PDF Downloads 187

Authors: Mostafa Jafarian Abyaneh, Khashayar Jafari, Vahab Toufigh

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The cost of experiments on different types of concrete has raised the demand for prediction of their behavior with numerical analysis. In this research, an advanced numerical model has been presented to predict the complete elastic-plastic behavior of polymer concrete (PC), high-strength concrete (HSC), high performance concrete (HPC) along with different steel fiber contents under uniaxial compression. The accuracy of the numerical response was satisfactory as compared to other conventional simple models such as Mohr-Coulomb and Drucker-Prager. In order to predict the complete elastic-plastic behavior of specimens including softening behavior, disturbed state concept (DSC) was implemented by nonlinear finite element analysis (NFEA) and hierarchical single surface (HISS) failure criterion, which is a failure surface without any singularity.

Keywords: disturbed state concept (DSC), hierarchical single surface (HISS) failure criterion, high performance concrete (HPC), high-strength concrete (HSC), nonlinear finite element analysis (NFEA), polymer concrete (PC), steel fibers, uniaxial compression test

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Authors: Christy M. Moen, Richard B. Townsley

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Introduction: Metastasis to the frontal bone in thyroid cancer is extremely rare. A literature review found only six cases of thyroid cancer that metastasised to the frontal bone, with two of those involving further bone sites. Case Report: The patient was originally referred to the Oral and Maxillofacial Surgery team with an isolated mass on her forehead. Biopsies were performed, which showed this was likely a metastatic deposit from thyroid cancer. CT-PET scan showed this was an isolated lesion. The patient had a total thyroidectomy, and the forehead lesion was managed with radiotherapy. On interval scanning, the patient’s bony lesion had increased in size and had new lung nodules, which likely represented further metastasis. Conclusion: Isolated bony metastases to the frontal bone are rare. An important clinical principle to remember is that a bony metastasis from an unknown primary is more likely than primary bone cancer.

Keywords: cancer, thyroid, head and neck, surgery

Procedia PDF Downloads 190

Authors: Sayyed Mostafa Ahmadi, Neda Raeesi

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Background and Objectives: Cervical spondylosis is a common problem that affects the adult spine and is the most common cause of radiculopathy and myelopathy in older patients. Anterior discectomy and fusion is a well-known technique in degenerative cervical disc disease. However, one of the late undesirable complications is adjacent disc degeneration, which affects about 91% of patients in ten years. Many factors can be effective in causing this complication, but some are still debatable. Discovering these risk factors and eliminating them can improve the quality of life. Methods: This is a retrospective cohort study. All patients who underwent anterior discectomy and fusion surgery in the neurosurgery ward of Imam Khomeini Hospital between 2013 and 2016 were evaluated. Their demographic information was collected. All patients were visited and examined for radiculopathy, myelopathy, and muscular force. At the same visit, all patients were asked to have a facelift, and neck profile, as well as a neck MRI(General Tesla 3). Preoperative graphs were used to measure the diameter of the cervical canal(Pavlov ratio) and to evaluate sagittal alignment(Cobb Angle). Preoperative MRI of patients was reviewed for anterior and posterior longitudinal ligament calcification. Result: In this study, 57 patients were studied. The mean age of patients was 50.63 years, and 49.1% were male. Only 3.5% of patients had anterior and posterior longitudinal ligament calcification. Symptomatic ASD was observed in 26.6%. The X-rays and MRIs showed evidence of 80.7% radiological ASD. Among patients who underwent one-level surgery, 20% had symptomatic ASD, but among patients who underwent two-level surgery, the rate of ASD was 50%.In other words, the higher the number of surfaces that are operated and fused, the higher the probability of symptomatic ASD(P-value <0.05). The X-rays and MRIs showed 80.7% of radiological ASD. Among patients who underwent surgery at one level, 78% had radiological ASD, and this number was 92% among patients who underwent two-level surgery(P-value> 0.05). Demographic variables such as age, sex, height, weight, and BMI did not have a significant effect on the incidence of radiological ASD(P-value> 0.05), but sex and height were two influential factors on symptomatic ASD(P-value <0.05). Other related variables such as family history, smoking and exercise also have no significant effect(P-value> 0.05). Radiographic variables such as Pavlov ratio and sagittal alignment were also unaffected by the incidence of radiological and symptomatic ASD(P-value> 0.05). The number of surgical surfaces and the incidence of anterior and posterior longitudinal ligament calcification before surgery also had no statistically significant effect(P-value> 0.05). In the study of the ability of the neck to move in different directions, none of these variables are statistically significant in the two groups with radiological and symptomatic ASD and the non-affected group(P-value> 0.05). Conclusion: According to the findings of this study, this disease is considered to be a multifactorial disease. The incidence of radiological ASD is much higher than symptomatic ASD (80.7% vs. 26.3%) and sex, height and number of fused surfaces are the only factors influencing the incidence of symptomatic ASD and no variable influences radiological ASD.

Keywords: risk factors, anterior neck disectomy and fusion, adjucent segment degeneration, complication

Procedia PDF Downloads 35

Authors: Johns Paul, Santhosh J. Nalluveettil, P. Purushothaman, M. Premdas

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Lunar landing is one of the most critical phases of lunar mission. The lander is provided with a soft landing system to prevent structural damage of lunar module by absorbing the landing shock and also assure stability during landing. Presently available software are not capable to simulate the rigid body dynamics coupled with contact simulation and elastic/plastic deformation analysis. Hence a separate mathematical model has been generated for studying the dynamics of a typical lunar soft lander. Parameters used in the analysis includes lunar surface slope, coefficient of friction, initial touchdown velocity (vertical and horizontal), mass and moment of inertia of lander, crushing force due to energy absorbing material in the legs, number of legs and geometry of lander. The mathematical model is capable to simulate plastic and elastic deformation of honey comb, frictional force between landing leg and lunar soil, surface contact simulation, lunar gravitational force, rigid body dynamics and linkage dynamics of inverted tripod landing gear. The non linear differential equations generated for studying the dynamics of lunar lander is solved by numerical method. Matlab programme has been used as a computer tool for solving the numerical equations. The position of each kinematic joint is defined by mathematical equations for the generation of equation of motion. All hinged locations are defined by position vectors with respect to body fixed coordinate. The vehicle rigid body rotations and motions about body coordinate are only due to the external forces and moments arise from footpad reaction force due to impact, footpad frictional force and weight of vehicle. All these force are mathematically simulated for the generation of equation of motion. The validation of mathematical model is done by two different phases. First phase is the validation of plastic deformation of crushable elements by employing conservation of energy principle. The second phase is the validation of rigid body dynamics of model by simulating a lander model in ADAMS software after replacing the crushable elements to elastic spring element. Simulation of plastic deformation along with rigid body dynamics and contact force cannot be modeled in ADAMS. Hence plastic element of primary strut is replaced with a spring element and analysis is carried out in ADAMS software. The same analysis is also carried out using the mathematical model where the simulation of honeycomb crushing is replaced by elastic spring deformation and compared the results with ADAMS analysis. The rotational motion of linkages and 6 degree of freedom motion of lunar Lander about its CG can be validated by ADAMS software by replacing crushing element to spring element. The model is also validated by the drop test results of 4 leg lunar lander. This paper presents the details of mathematical model generated and its validation.

Keywords: honeycomb, landing leg tripod, lunar lander, primary link, secondary link

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Authors: Daniel Y. Abebe, Jaehyouk Choi

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Link-to-column connection in eccentrically braced frames (EBF) has been a critical problem since the link flange connected to the column fractured prior to the required link rotation. Even though the problem in link-to-column connection still exist, the use of an eccentrically braced frame (EBF) is increasing day by day as EBF have high elastic stiffness, stable inelastic response under repeated lateral loading, and excellent ductility and energy dissipation capacity. In order to address this problem, a reduced web and flange link section is proposed and evaluated in this study. Reducing the web with holes makes the link to control the failure at the edge of holes introduced. Reducing the flange allows the link to control the location at which the plastic hinge is formed. Thus, the failure supposed to occur in the link flange connected at the connection move to the web and to the reduced link flange. Nonlinear FE analysis and experimental investigations have been done on the developed links, and the result shows that the link satisfies the plastic rotation limit recommended in AICS-360-10. Design equations that define the behavior of the proposed link have been recommended, and the equations were verified through the experimental and FE analysis results.

Keywords: EBFs, earthquake disaster, link-to-column connection, reduced link section

Procedia PDF Downloads 353

Authors: John Joseph S. Martis, Rohanchandra R. Gatty, Aaron Jose Fernandes, Rahul P. Nambiar

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Introduction: Surgery for breast cancer is either mastectomy or breast conservation surgery. The most commonly used incision for modified radical mastectomy is the transverse Stewart incision. But this incision may have the disadvantage of causing disparity between the closure lines of superior and inferior skin flaps in mastectomy and can cause overhanging of soft tissue below and behind the axilla. The curvizigzag incision, on principle, may help in this regard and can prevent scar migration beyond the anterior axillary line. This study aims to compare the two incisions in this regard. Methods: 100 patients with cancer of breast were included in the study after satisfying inclusion and exclusion criteria. They underwent surgery at Father Muller Medical College, Mangalore, India, between November 2019 to September 2021. The patients were divided into two groups. Group A patients were subjected to modified radical mastectomy with curvizigzag incision and group B patients with transverse Stewart incision. Results: Seroma on postoperative day1, day 2 was 0% in both the groups. Seroma on postoperative day 30 was present in 14% of patients in group B. 60% of patients in group B had sag of soft tissue below and behind the axilla, and none of the patients in group A had this problem. In 64% of the patients in group B, the incision crossed the anterior axillary fold, 64% of the patients in group B had tension in the incision site while approximation of the skin flaps. Conclusion: Curvizigzag incision is statistically better with lesser complications when compared to the transverse Stewart incision for modified radical mastectomy for carcinoma breast.

Keywords: breast cancer, curvizigzag incision, transverse Stewart incision, seroma, modified radical mastectomy

Procedia PDF Downloads 72

Authors: N. Singh, G. K. Darbha

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Since the last decade, a wave of research has begun to study the prevalence and impact of ever-increasing plastic pollution in the environment. The wide application and ubiquitous distribution of plastic have become a global concern due to its persistent nature. The disposal of plastics has emerged as one of the major challenges for waste management landfills. Microplastics (MPs) have found its existence in almost every environment, from the high altitude mountain lake to the deep sea sediments, polar icebergs, coral reefs, estuaries, beaches, and river, etc. Microplastics are fragments of plastics with size less than 5 mm. Microplastics can be classified as primary microplastics and secondary microplastics. Primary microplastics includes purposefully introduced microplastics into the end products for consumers (microbeads used in facial cleansers, personal care product, etc.), pellets (used in manufacturing industries) or fibres (from textile industries) which finally enters into the environment. Secondary microplastics are formed by disintegration of larger fragments under the exposure of sunlight, mechanical abrasive forces by rain, waves, wind and/or water. A number of factors affect the quantity of microplastic present in freshwater environments. In addition to physical forces, human population density proximal to the water body, proximity to urban centres, water residence time, and size of the water body also affects plastic properties. With time, other complex processes in nature such as physical, chemical and biological break down plastics by interfering with its structural integrity. Several studies demonstrate that microplastics found in wastewater sludge being used as manure for agricultural fields, thus having the tendency to alter the soil environment condition influencing the microbial population as well. Inadequate data are available on the fate and transport of microplastics under varying environmental conditions that are required to supplement important information for further research. In addition, microplastics have the tendency to absorb heavy metals and hydrophobic organic contaminants such as PAHs and PCBs from its surroundings and thus acting as carriers for these contaminants in the environment system. In this study, three kinds of microplastics (polyethylene, polypropylene and expanded polystyrene) of different densities were chosen. Plastic samples were placed in sand with different aqueous media (distilled water, surface water, groundwater and marine water). It was incubated at varying temperatures (25, 35 and 40 °C) and agitation levels (rpm). The results show that the number of plastic fragments enhanced with increase in temperature and agitation speed. Moreover, the rate of disintegration of expanded polystyrene is high compared to other plastics. These results demonstrate that temperature, salinity, and mechanical abrasion plays a major role in degradation of plastics. Since weathered microplastics are more harmful as compared to the virgin microplastics, long-term studies involving other environmental factors are needed to have a better understanding of degradation of plastics.

Keywords: environmental contamination, fragmentation, microplastics, temperature, weathering

Procedia PDF Downloads 138

Authors: Sangram Shamrao Patil, Hara Mohan Jena

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Phthalates are among the most common organic pollutant since they have become widespread in the environment and found in sediments, natural waters, soils, plants, landfill leachates, biota including human tissue and aquatic organisms. Diethyl phthalate (DEP) is a low molecular weight phthalate which has wide applications as plasticizer and become a major cause of environmental pollution. Environmental protection agency (EPA) listed DEP as priority pollutant because of its toxicity and they recommended human health ambient water quality criterion for diethyl phthalate (DEP) as 4 mg/l. Therefore, wastes containing phthalates require proper treatment before being discharged into the environment. Biodegradation is attractive and efficient treatment method as it is cost effective and produces non-toxic end products. In the present study, a DEP degrading aerobic bacterium was isolated from soil contaminated with plastic industry wastewater. Morphological and biochemical characteristics of isolate were performed. 16S rRNA sequencing and phylogenetic analysis of isolate was carried out and it was identified as Empedobacter brevis. Isolate has been found to tolerate up to 1650 mg/l of DEP. This study will be significant for exploring an application of microbes for remediation of phthalates and development of a suitable bioreactor.

Keywords: diethyl phthalate, plasticizer, pollutant, biodegradation

Procedia PDF Downloads 251

Authors: Lingyu Ding, Hongxia Hua, Hanfei Zhu, Jinling Lu, Qin Xu

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Background: Postoperative pain is a prevalent problem leading to many adverse outcomes in surgical patients. Virtual reality (VR) is an emerging non-pharmacological method of postoperative pain relief, but the effects of it are not clear. This review aimed to explore the effects of VR on relieving postoperative pain. Methods: We searched PubMed, Embase, Web of Science, and other databases from inception to November 2019 to get the eligible studies. Meta-analyses were conducted to compare VR and usual care for relieving postoperative pain. Subgroup analyses and sensitivity analyses were performed to explain the heterogeneity. Results: Overall, 8 randomized control trials (RCTs) enrolling 723 participants were included. Our results demonstrated that the patients receiving the VR intervention had lower postoperative pain scores than those receiving the usual care. One subgroup analysis revealed that VR could relieve postoperative pain both in minor surgery and major surgery. Another subgroup analysis demonstrated a significant reduction in postoperative pain among patients receiving VR during the intraoperative and the postoperative periods. However, there was no significant postoperative pain relief when receiving VR during the preoperative period. Additionally, significant improvements in postoperative satisfaction were reported in two studies. However, another two studies included found that VR could not affect physiological parameters related to pain. Conclusion: Applying VR can relieve postoperative pain effectively. The type of surgery and timing of using VR are the main sources of heterogeneity. More rigorous studies about the relationship between VR and postoperative pain relief will be needed.

Keywords: meta-analysis, postoperative pain, systematic review, virtual reality

Procedia PDF Downloads 116

Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

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Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

Procedia PDF Downloads 50