Background: The NovoSorb ® Biodegradable Temporising Matrix (BTM) is a synthetic polyurethane dermal matrix used to reconstruct complex wounds including deep dermal and full-thickness burns, necrotising fasciitis and free flap donor site. We hope to further explore its potential applications in this series. Methods: Patients who received BTM application across four centres over an 18-month period were included. Patients were followed up to assess BTM and graft take, the aesthetic, the return of sensation and complications. Results: A total of 27 patients with 35 wounds were identified with a range of aetiologies. Thirty-three wounds had 100% integration of BTM at the time of sealing membrane removal. Seven wounds had partial graft loss that later healed by secondary intention. In two cases, re-epithelialisation occurred with BTM alone without split-skin graft. Conclusion: BTM offers a safe and reliable reconstructive option in challenging wounds that would otherwise require more complex operations.

Introduction: Cystic fibrosis (CF) predominantly affects young adults. Accurate radiological assessment of pulmonary disease is vital for predicting exacerbations, one of the leading causes of morbidity and mortality. We evaluated the image quality of model-based iterative reconstruction (MBIR) ultra-low-dose CT chest (ULD-CT) in CF evaluation. Methods: We compared ULD-CT with standard adaptive statistical iterative reconstruction (ASIR) low-dose CT (LD-CT). Subjective assessment of contrast and noise were performed for each study. Background noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated and compared between the CT studies. Conspicuity of major structures was assessed. These aspects of image quality were compared to determine whether ULD-CT was superior to LD-CT in assessment of CF. Results: The ULD-CT achieved median effective dose of 0.073 mSv, comparable to one standard chest radiograph and significantly lower than the median LD-CT dose of 1.22 mSv. ULD-CT had lower subjective contrast and higher subjective noise when compared to LD-CT. Objectively measured background noise was lower in ULD-CT (16.33 HU vs 38.53 HU, P < 0.0001) compared to LD-CT. ULD-CT had higher median CNR (52.65 vs 22.09, P < 0.0001) and SNR in lung (9.08 vs 7.29, P = 0.002) compared to LD-CT. ULD-CT was equal to LD-CT in identification of trachea, bronchi, pleural and pericardium. Interobserver reliability showed agreement of 80-92%. Conclusions: The image quality of ULD-CT is similar to LD-CT, at 1/16th the dose. MBIR constructed ULD-CT is an effective imaging modality for CF surveillance, with potential applications in other disease settings.

Background: Early mobilization is an important therapeutic goal after total knee replacement and total hip replacement. Orthostatic hypotension and orthostatic intolerance can impede mobilization. Midodrine hydrochloride, an orally administered vasoconstrictor, may improve blood pressure and diminish the prevalence of adverse mobilization events. Methods: We conducted a pilot change-of-practice study. Two cohorts, each comprising 10 patients managed with total knee replacement and 10 patients managed with total hip replacement, were managed with blood pressure-adjusted midodrine, which was administered 3 times daily for the first 72 hours postoperatively at either a low dose (2.5 or 5 mg) or a higher dose (5 or 10 mg). These patients were then matched with an equivalent preintervention cohort of patients. Results: The midodrine protocol was instituted effectively and with high compliance. Hypotension was uncommon across all groups, with the mean lowest systolic blood pressure ranging from 110 to 121 mm Hg. Moreover, adverse mobilization events were uncommon across all groups (prevalence, 9.6% in the control group, 5.6% in the low-dose group, and 2.9% in the high-dose group) (p = 0.046 for the high-dose group versus the control group). A midodrine dose of 10 mg generated a significant mean dose-related systolic blood pressure increase of 14 mm Hg at 2 hours after administration (p < 0.001). There were no significant differences between the groups in terms of mean systolic blood pressure, biochemical markers, or intravenous therapy administration. Conclusions: A dose of 10 mg was found to achieve a significant systolic blood pressure response at 2 hours after administration and, in patients who received higher-dose midodrine, adverse mobilization events appeared less common. Additional investigation with a blinded randomized controlled trial, utilizing 10 mg of midodrine 2 hours before mobilization, would be needed to confirm the efficacy of midodrine therapy. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

No abstract