OBJECTIVES:Anterior nasal septal perforations (NSPs) can cause significant morbidity and are often challenging to repair in revision settings where posterior septal mucosa lack integrity, are difficult to raise, or are traumatized. We describe an anteriorly pedicled nasal floor mucoperiosteal flap based on the superior labial artery (SLA) and report anatomical and symptomatic outcomes in patients where traditional anterior ethmoid and greater palatine artery flaps are not readily available. METHODS:A case series of consecutive adult patients undergoing endoscopic NSP repair using an SLA-based anterior pedicled floor flap was performed. Outcomes included anatomical closure, Miglani endoscopic score, symptom evaluation with SNOT-22 and nasal subdomain scores. The definition of outcome was defined by both resolution of clinical symptoms and anatomical closure, with "complete" being both. RESULTS:Twenty-one patients (age 41.5 ± 10.9 years; 57.1% female) were followed for 9.4 ± 3.6 months. Most perforations were anterior (85.7%) and iatrogenic (surgical trauma) in etiology, with a mean area of 92.6 ± 71.9 mm2. Anatomical closure was achieved in 90.5 [71.1-97.3]% of cases, with partial closure in 9.5 [2.7-28.9]%. Endoscopy assessment improved (Miglani 3.14 ± 1.56 v 0.62 ± 0.86; p < 0.001). Symptoms improved in both nasal subdomain (14.1 ± 6.2 v 3.5 ± 3.2, p < 0.001) and SNOT-22 (38.6 ± 21.8 v 9.8 ± 11.5, p < 0.001). Complete success (anatomical closure with symptom resolution) was achieved in 90.5 [71.1-97.3]%. CONCLUSIONS:The SLA-based nasal floor flap provides high closure rates and symptomatic improvement in NSP cases where traditional septal flaps are not feasible. LEVEL OF EVIDENCE: 4:
Skin aging is a multi-level pathological process characterized by heterogeneity and a close interconnection of molecular and cellular disturbances. These include loss of proteostasis and epigenetic alterations, activation of specific pro-inflammatory cascades, mitochondrial dysfunction, and persistent disruption of intercellular communication, among others. The accumulation of such damages poses a significant methodological challenge for contemporary local geroprotection, necessitating a move beyond mono-therapeutic approaches. This review analyzes the pathogenetic foundations for developing combined strategies. The primary focus is on the synergistic potential of combining Intense Pulsed Light (IPL) with injectable cosmetology methods. Within this framework, the potential for targeted delivery of vitamins, peptides, amino acids, and trace elements in the form of mechano-chemical conjugates is evaluated for correcting deep metabolic deficits associated with aging. Based on a systematization of current data, a conceptual model is formulated that substantiates the need for personalized combined protocols. It is proposed that such a multimodal strategy, sequentially targeting various pathogenetic links – from neutralizing exogenous aggressors and mitigating chronic inflammation to directly restoring the extracellular matrix and cellular homeostasis – can not only effectively correct the visual manifestations of aging but also influence fundamental biological processes. Thus, a rational combination of IPL therapy and modern bioreparants is considered a promising avenue for achieving sustainable clinical results in correcting both chronological and photo-induced skin aging.
Netakimab is a humanized anti-interleukin-17A monoclonal antibody, it has marketing approval for treatment of adult patients with moderate-tosevere plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. This paper provides the results of the first 12-week period of phase III BCD-085-16/PLANETA-KIDS clinical study.Objective. The aim of the BCD-085-16/PLANETA-KIDS is to evaluate netakimab efficacy and safety in pediatric patients 6+ years old with moderate-to-severe plaque psoriasis.Methods. BCD-085-16/PLANETA-KIDS (NCT06640517) is a randomized, double-blind, placebo-controlled phase III clinical study with open-label active-comparator arm (adalimumab). A total of 155 male and female patients aged from 6 to 18 years with confirmed moderate-to-severe plaque psoriasis were randomized to receive netakimab (n = 83), placebo (n = 35), or adalimumab (n = 37). Netakimab dosage was weight adjusted: for patients weighing 50 kg or more netakimab dose was 120 mg (two injections of 60 mg/ml each), for patients weighing less than 50 kg netakimab dose was 60 mg (one injection of 60 mg/ml). Patients in the Netakimab group received netakimab subcutaneously once per week for the first three weeks (induction) and once every 4 weeks thereafter (maintenance). Patients in the Placebo group received placebo in blinded manner like netakimab. Adalimumab was administered in open-label way in doses recommended by the product’s SmPC. In this study co-primary efficacy endpoints were the proportion of patients achieving PASI75 and sPGA0/1 at week 12.Results. Netakimab has shown superiority over placebo for both co-primary endpoints. The proportion of patients achieving PASI75 at week 12 was 89.2% in the Netakimab group and 14.3% in the Placebo group, odds ratio (OR) 59.0, 95% CI [16.5; 211.5] (p < 0.0001). The proportion of patients achieving sPGA0/1 at week 12 was 83.1% in the Netakimab group and 8.6% in the Placebo group, OR 54.9, 95% CI [14.6; 206.5] (p < 0.0001). The subgroup analysis has shown consistent netakimab superiority over placebo for both co-primary endpoints, regardless of age, body weight and psoriasis severity. Throughout the 12-week period netakimab has shown favorable safety profile comparable to that in the Placebo group.Conclusion. The results of the 12-week period in the BCD-085-16/PLANETA-KIDS study have shown high efficacy of netakimab compared with placebo with favorable safety profile in children aged 6 years and older and adolescents with moderate-to-severe plaque psoriasis.
The authors present a patient with delayed (12 months) manifestation of post-traumatic false aneurysm of deep femoral artery after previous lower limb injury. This report is of great scientific and practical interest due to rare similar clinical scenarios in modern vascular surgery and no coverage of long-term subclinical course of traumatic vascular complications in specialized literature. A feature of this case is no specialized surgical care early after injury due to minimal clinical symptoms (moderate pain syndrome without visual signs of damage). This led to a one-year-long “diagnostic window”. Treatment strategy upon admission included a hybrid approach with baseline endovascular embolization of the afferent artery and subsequent open surgical treatment of false aneurysm and debridement of thrombotic masses. This case demonstrates the role of careful monitoring of patients with limb injuries, even in the absence of obvious signs of vascular damage in acute period. Long-term subclinical course of post-traumatic pseudoaneurysm, followed by abrupt decompensation, highlights the need for diagnostic vigilance in all types of injuries. A combined approach with endovascular and open techniques is effective in treating such complications.
The dragonfly flap is a novel endoscopic technique for the repair of large nasal septal perforations using a bilaterally extended mucosal flap based on the ethmoidal arteries, with optional sphenopalatine arterial support. Its wing-like configuration provides broad, well-vascularized mucosal coverage that allows tension-free closure of large or unsupported septal defects. Early clinical results demonstrate high closure rates with significant symptomatic improvement and minimal morbidity.
