Thomas Imahiyerobo

Comparison of Antibiotic-Coated versus Uncoated Porcine Dermal Matrix.

Background: The objective of this study was to evaluate the antimicrobial performance of a rifampin/minocycline-coated, non–cross-linked, acellular porcine dermal matrix (XenMatrix AB) compared to an uncoated, non–cross-linked, acellular porcine dermal matrix (Strattice) after implantation/inoculation with methicillin-resistant Staphylococcus aureus or Escherichia coli in a dorsal rabbit model. Methods: Forty male New Zealand White rabbits were bilaterally implanted with XenMatrix AB or Strattice grafts and inoculated with clinically isolated methicillin-resistant S. aureus (5 × 107 colony-forming units/ml) or E. coli (1 × 107 colony-forming units/ml). At 2 and 8 weeks, sites were analyzed for viable methicillin-resistant S. aureus/E. coli colony-forming units, abscess formation, and histologic response (n = 5 rabbits per group per bacterium per time point). Results: XenMatrix AB completely inhibited bacterial colonization of the graft, inhibited abscess formation, reduced inflammation and encapsulation, and improved neovascularization compared with Strattice. XenMatrix AB implants exhibited significantly fewer colony-forming units compared with Strattice implants at 2 weeks (methicillin-resistant S. aureus) (p < 0.01) and at 2 and 8 weeks (E. coli) (p < 0.05). In addition, XenMatrix AB implants demonstrated a significantly lower abscess score at 2 weeks (methicillin-resistant S. aureus) and 8 weeks (E. coli) (p < 0.01 in both cases). For both types of bacteria and both time points evaluated, XenMatrix AB implants exhibited minimal inflammation and encapsulation and a lack of neutrophils. In contrast, Strattice implants displayed marked inflammatory and neutrophilic responses and moderate encapsulation. Conclusions: This study demonstrated the antimicrobial performance of a rifampin/minocycline-coated bioprosthetic (XenMatrix AB) in a rabbit inoculation model. XenMatrix AB completely inhibited bacterial colonization of the graft, with minimal host inflammation and encapsulation, and improved neovascularization compared with Strattice.

310 Predictors of Preoperative Developmental Delay in Nonsyndromic Sagittal Craniosynostosis.

Patients with nonsyndromic sagittal craniosynostosis (SC) were previously thought to have normal neurocognitive development; however, a pattern of mild delays has been described in these patients. We reviewed our patients with SC to identify potential perinatal risk factors that serve as indicators for subsequent developmental delay.Nonsyndromic patients with SC (n = 66) completed preoperative Bayley Scales of Infant and Toddler Development (III) with a single examiner between August 2009 and April 2015. Patients were classified as having no delays (n = 52; 79%) or having delays (n = 14; 21%) below the ninth percentile in one or more area(s) of development. Mean differences were compared using Multivariate Analyses of Variance.Participants were mostly male (79%) and aged 2 to 12 months at testing. There were no group differences in sociodemographic categories. Prenatally, patients in the group with delays vs the group with no delays had lower gestational age in weeks (36.9 vs 39.2, P <.000) with higher rates of gestational diabetes (36% vs 6%, P =.002) and premature rupture of membranes (14% vs 0%, P =.006). There were no group differences in maternal hypertension, maternal age, breech position, preterm labor, emergency cesarean delivery, or failure to progress. At birth, patients with delays had lower birth weight in grams (2982 vs 3359, P =.041), higher rates of respiratory distress (29% vs 4%, P =.005), additional medical diagnoses (57% vs 15%, P =.001), and longer NICU stays in weeks (1.6 vs 0.2, P =.001). There were no differences for infection, hyperbilirubinemia, age at SC diagnosis, or subsequent surgery age.Patients with SC with delays in development had a lower gestational age and birth weight with more prenatal and birth complications. Further studies are required to validate appropriate follow-up and genetic testing in these groups.INTRODUCTION Patients with nonsyndromic sagittal craniosynostosis (SC) were previously thought to have normal neurocognitive development; however, a pattern of mild delays has been described in these patients. We reviewed our patients with SC to identify potential perinatal risk factors that serve as indicators for subsequent developmental delay. METHODS Nonsyndromic patients with SC (n = 66) completed preoperative Bayley Scales of Infant and Toddler Development (III) with a single examiner between August 2009 and April 2015. Patients were classified as having no delays (n = 52; 79%) or having delays (n = 14; 21%) below the ninth percentile in one or more area(s) of development. Mean differences were compared using Multivariate Analyses of Variance. RESULTS Participants were mostly male (79%) and aged 2 to 12 months at testing. There were no group differences in sociodemographic categories. Prenatally, patients in the group with delays vs the group with no delays had lower gestational age in weeks (36.9 vs 39.2, P < .000) with higher rates of gestational diabetes (36% vs 6%, P = .002) and premature rupture of membranes (14% vs 0%, P = .006). There were no group differences in maternal hypertension, maternal age, breech position, preterm labor, emergency cesarean delivery, or failure to progress. At birth, patients with delays had lower birth weight in grams (2982 vs 3359, P = .041), higher rates of respiratory distress (29% vs 4%, P = .005), additional medical diagnoses (57% vs 15%, P = .001), and longer NICU stays in weeks (1.6 vs 0.2, P = .001). There were no differences for infection, hyperbilirubinemia, age at SC diagnosis, or subsequent surgery age. CONCLUSION Patients with SC with delays in development had a lower gestational age and birth weight with more prenatal and birth complications. Further studies are required to validate appropriate follow-up and genetic testing in these groups.

Abstract: Plastic Multilayered Closure in Nonidiopathic Scoliosis Significantly Reduces the Risk of Wound Complications in a Pediatric Population

METHODS: Patients with a diagnosis of nonidiopathic scoliosis undergoing primary or revision growth friendly instrumentation or fusion during 2014 to 2016 were included. Clinical charts and operative reports were reviewed. The SSI and wound complication risk of patients undergoing PMC was compared to standard closure. Additionally, the mean Risk Severity Score (RSS) for SSI, which utilizes patient characteristics to calculate the probability of SSI, was calculated to compare the observed (actual risk) and expected risk (RSS).

Proteus Syndrome With a Cranial Intraosseous Lipoma

Intraosseous lipomas are almost exclusively seen in the long bones. Presence in the craniofacial skeleton is extremely rare. A 7-year-old male is presented with a marked craniofacial deformation from a bony tumor containing an intraosseous lipoma. This finding established a clinical diagnosis of Proteus syndrome. Given the size of the tumor, producing an extensive deformity, three-dimensional modeling was used to generate a three-dimensional printed implant. The process to achieve a successful outcome is herein described.