The local environment and the defect features have made the skull one of the most difficult regions to repair. Finding alternative strategies to repair large cranial defects, thereby avoiding the current limitations of autograft or polymeric and ceramic prostheses constitute an unmet need. In this study, the regeneration of an 8 mm critical‐sized calvarial defect treated by autograft or by a monetite scaffold directly placed in the defect or preimplanted (either cranial bone transplant or subcutaneous pocket) and then transplanted within the bone defect is compared. The data reveal that transplantation of preimplanted monetite transplant scaffolds greatly improves the skull vault closure compared to subcutaneously preimplanted or directly placed materials. Autografts, while clearly filling the defect volume with bone appear effective since bone volume inside the defect volume is obviously high, but are not well fused to the skull. The preimplantation site has a large influence on the regeneration of the defect. Transplantation of induced bone inside materials has the potential to reduce the need for autograft harvest without damaging the skeleton. This first demonstration indicates that cranial repair may be possible without recourse to bioactives or cultured cell therapies.
Background: Self-inflicted trauma (SIT) is a public health issue ranking 4th as leading cause of death and disability in young adults. Methods: Retrospective descriptive analysis of patients admitted to a level 1 trauma centre with self-inflicted injuries, 2008-2013. Results: Over a 5-year period, 268 patients with SIT presented to our hospital, 177 (66%) male, average age 39.4 years (SD 16). The most common mechanism of injury was stabbing, (47%), followed by jumping (26.86%). Jumpers had higher ISS (22 v. 9). Seasonal variation showed summer with highest incidence (34%), winter having the lowest (17%). Patients from rural areas accounted for 28%, these were younger (30 v. 42 years, p = 0.002), had lower ISS (9 v. 14, p = 0.007), presented with more firearm injuries (18.6% vs. 2.3%). Overall, 63 (23%) patients had pre-existing psychiatric disease; these patients had longer LOS (20 v. 7 days, p = 0.002), and had jumping from height as predominant mechanism (p = 0.01). Mortality was 13.8%. Patients that died were older (42 v. 30 years, p = 0.002), had higher ISS (14 v. 9, p = 0.007), longer LOS (13.5 v. 6 days, p = 0.004), with fall being the predominant mechanism associated with mortality (p < 0.0001). Conclusion:Our study defines and characterizes the population at risk for SIT in an attempt to implement appropriate prevention strategies and improve the existing post-injury care pathway.Abdominal compartment syndrome in the child. Gilgamesh Eamer,* Ioana Bratu.
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