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Demographic profile, clinical presentation, and procedure information Number of patients and percentage Total number of patients N = 48 Gender Males 33 (68.8%) Females 15 (31.2%) Age < 12 months 20 (41.6%) 12–24 months 23 (47.9%) > 24 months 5 (10.4%) Duration of symptoms < 24 h 6 (12.5%) 24–48 h 30 (62.5%) > 48 h 12 (25%) Clinical presentation Pain 48 (100%) Rectal bleeding 21 (43.7%) Vomiting 48 (100%) Palpable abdominal mass 19 (39.5%) USG findings Ileocolic intussusception 48 (100%) Volume of fluid used for reduction 500–1000 ml 31 (64.5%) 1000–2000 ml 17 (35.4%) Time taken for reduction < 5 min 17 (38.6%) 5–10 min 24 (54.5%) > 10 min 3 (6.2%) Fig. 1 Patient A with appendicocecal intussusception Chand et al. Annals of Pediatric Surgery (2021) 17:9 Page 3 of 7 In all the three cases in which there was failure of the procedure, lead points were present, necessitating surgery. One of 44 (2.2%) patients in whom non-operative reduction could be achieved had recurrence after 4 months of initial reduction, which was again reduced hydrostatically. The child was kept on follow-up and did not have any re-recurrence over a period of 4 years in the duration of the present study. In this study, the success rate of reduction was 91.6%, the recurrence rate was 2.2%, and the complication rate was 2%. The period of follow-up ranged from the shortest being 1 month to the longest being 6 years. The correlation matrix is given in Table 3. Age was not correlated with duration, volume of fluids, and time for recovery. Symptoms duration is correlated with both volume of fluids used and time for recovery (Pearson’s correlation coefficient 0.5 (p value = 0.0001) and 0.5 (p value = 0.0002). Discussion An ideal treatment for intussusception can be defined as one that is efficacious, safest, and painless for the patient, comfortably performed by the user, replicable, and avoids delay in treatment of possible complications. Intussusception was first described by Paul Barbette in 1674 and was further characterized by John Hunter in 1793 [1]. Various methods of reduction both operative and non-operative have been tried over the last 300 years [2]. In 1952, Ravitch and Mc Cune published a landmark series in which they used barium sulfate enema to diagnose as well as reduce intussusception, calling this “hydrostatic reduction.” They reported 73.6% success rate, no deaths, and 5.55% recurrence rate [3], after which attention shifted to non-operative reduction. The successful reduction of intussusception by saline enema under real-time sonography guidance was first described in 1982 by Kim et al. [4]. The various methods of non-operative reduction are pneumatic or hydrostatic, under fluoroscopy, or USG guidance done in the radiology suite either by surgeons themselves or assisted by a radiologist. In the radiology suite, this procedure is generally performed on an awake child or with minimal sedation used on an ad hoc basis [4]. All these procedures have variable success rates with no defined gold standard of treatment. Treatment is in accordance with the operator’s comfort and availability of resources. Surgical exploration remains a fallback procedure in case of failure or complication. Fig. 2 Patient D with failed non-operative reduction Chand et al. Annals of Pediatric Surgery (2021) 17:9 Page 4 of 7 Fig. 3 Patient D with colonic perforation (marked with silk) and manually reduced necrotic intussusceptum Table 2 Demographic features, clinical presentation, and procedure information of patients with failed non-operative reduction/ perforation Shores, clinical director of the arm/hand transplant program. “He’s given us great hope for what people are capable of accomplishing after these transplants.” Marrocco’s progress laid the foundation for the department to complete another above-elbow transplant in June 2015. The patient was a man who’d fallen from a hotel balcony; during the fall, his arm tore off near the shoulder. The team expects substantial return of elbow strength and motion and meaningful return of hand function, Shores says. Along with the painstaking skills and techniques required to prepare tissue, bone, muscle, blood vessels and nerves to support a transplant, what has allowed the program to move forward so dramatically is the minimal immunosuppression protocol its faculty members have been developing over the last two decades. Shifting between Brandacher’s lab and the clinic for innovations and adjustments, the protocol uses donor bone marrow to shrink the typical three-medication immunosuppressive protocol down to just one drug. Ongoing preclinical large animal models suggest it may be possible to remove the remaining medication after one month of treatment, eliminating the need for a lifelong regimen altogether. “We’ve been pioneers in the field in regard to decreasing the burden of immunosuppression in patients getting transplants. We’re making excellent progress with the protocol,” Shores says. Besides representing a significant leap for the field, the protocol also has the potential to increase the pool of candidates for hand transplantation. And there is no reason, once fully proven, that it can’t translate to solid organ transplant, opening up brand-new possibilities for kidney, heart and liver patients. Exploring the Vanguard of Transplantation: Hand, Face and Urogenital RECONSTRUCTIVE TRANSPLANT “Transplant is now accepted as a bona fide tool to restore both form and function in patients with devastating damage.” 6 | Plastic and Reconstructive Surgery Face Transplant Since the world’s first face transplant in 2005, only nine have been completed in the U.S. and 35 worldwide. Given the complexity of the procedure, facial transplantation has been limited to patients with severe facial deformities. Following the success of the arm/hand transplant program, a multidisciplinary team at Johns Hopkins, including plastic and reconstructive surgeons, ENT surgeons, oculoplastic surgeons, and critical care and anesthesiologists, has been preparing for face transplants. “A critical aspect of our facial transplant program is the collaborative effort of these different specialties coming together, providing their expertise, and forming the very best that Johns Hopkins Medicine offers for our potential recipients,” says Amir Dorafshar, clinical co-director of the Face Transplant Program. The multidisciplinary team has identified a potential recipient and recently trained surgeons from various backgrounds to work cohesively in a synchronized fashion to perform one of the largest transplants to date, Dorafshar says. Working in close collaboration with the Johns Hopkins Applied Physics Laboratory and Walter Reed National Military Medical Center, the team will use the latest technology—customized cutting templates with threedimensional tracking, along with real-time cephalometry—to guide surgeons as they cut and attach face-jaw-teeth segments to ensure optimal positioning and functionality of the transplant, says Chad Gordon, clinical co-director of the Face Transplant Program and Multidisciplinary Adult Cranioplasty Center. This patent-pending technology is designed to minimize the follow-up revision surgeries common in the past, when surgeons had no way of knowing which microscopic bone cuts, measurements and angles would maximize functionality until the surgery was complete. “It’s like GPS for face transplant,” Gordon says. “If you get into a traffic jam based on unexpected findings and need a detour to get someplace better, quicker and safer, you simply hit adjust. That’s what we have now. You just click to see if you’re doing the right job, or if you need to adjust the plan on the fly.” The team is looking forward to putting its preparation into action. “Our teams are trained and ready,” Dorafshar says. “We have put into place the necessary infrastructure and team-oriented framework for many other face transplants to come. Using the unique immune modulation protocol with minimal immunosuppression, the team is ready to broaden the pool of candidates who could benefit not only from face transplant, but also eyelid, nose or lip transplants.” “It’s like GPS for face transplant.” Volume 136, Number 2 • Hybrid Occlusion and Cephalometry experiment, which did not show any deviations greater than 3 mm or 2 degrees from target measurements (Table 5). The plastic model experiment represents an idealized procedure with highly accurate patient-to-model registration error (0.727 mm and 0.306 mm for the plastic skull model donorandrecipientcomparedwith122mmandThe human son of post–faceplanned outcomdifferences in Medegrees)/SNB (In the comparisvaluesrelativetoFig. 6. Lateral view of the human cadaver before transplantand recipient), after transplantation, and the planned outcodots denote the measured landmark positions in each moFrontal three-

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