Microsurgery without a microscope.
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Humans↗
Biomedical subjects
M Kon
Publications and source records attributed to M Kon.
Muscular urinary sphincter: electrically stimulated myoplasty for functional sphincter reconstruction.
PURPOSE: To reconstruct an electrically stimulated muscular urinary sphincter (MUS) using a tailored gracilis muscle free flap with intact nerve. MATERIALS AND METHODS: Unilateral surgically tailored gracilis muscle free flaps were transferred into the pelvis in eight dogs, leaving the obturator nerve intact. The muscle's pedicle vessels were anastomosed to the inferior epigastric artery and vein in the pelvis and the muscle was wrapped around the bladder neck. Electrodes were inserted into the MUS and connected to a programmable pulse generator. After 8 weeks of training the MUS, the pulse generator was programmed to be "on" for 4 hours and "off' for 15 minutes in a continuous cycle. Urodynamic studies were performed periodically, and at the end of the experiment the MUS and proximal urethra were harvested for histology. Three control dogs had sham operations. RESULTS: All MUS's functioned well following the procedure. Histology of the MUS/urethra complex showed no evidence of stricture. Except for one dog, all urethras were easily catheterized. CONCLUSIONS: This electrically stimulated innervated free-flap MUS technique effectively increases bladder outlet resistance without producing urethral obstruction.
Animals↗
Reversed palmaris longus muscle causing effort-related median nerve compression.
Two cases of effort-related distal median nerve compression in the dominant forearm caused by a reversed palmaris longus muscle are presented. Simple resection of the muscle belly was performed. Carpal tunnel release was done in one case, but in retrospect this was probably not necessary.
Adolescent↗
Amount of hydroxyl radical on calcium-ion-implanted titanium and point of zero charge of constituent oxide of the surface-modified layer.
To compare the surface properties of calcium-ion (Ca2+)-implanted titanium with those of titanium and to investigate the mechanism of bone conductivity of Ca2+-implanted titanium, amounts of hydroxyl radical of Ca2+-implanted titanium and titanium were estimated. Also, the point of zero charge (p.z.c.) of oxide constituting surface oxides of Ca2+-implanted titanium and titanium was determined. Results showed that the amount of active hydroxyl radical on Ca2+-implanted titanium was found to be significantly larger than that on titanium, indicating that the number of electric-charging sites of Ca2+-implanted titanium in electrolyte is more than that of titanium. The p.z.c. values of rutile (TiO2), anatase (TiO2), and perovskite (CaTiO3), were estimated to be 4.6, 5.9, and 8.1, respectively. Thus, Ca2+-implanted titanium surface is charged more positively in bioliquid than titanium, accelerating the adsorption of phosphate ions.
Journal Article↗
Function of rat skeletal muscles after storage at 10 degrees C in various preservation solutions.
1. The purpose of this study was to assess the potential of various preservation solutions, orginally designed for solid organs, to protect muscle function during cold storage. 2. The soleus (SOL) and the cutaneous trunci (CT) muscle from the rat were isolated and stored for 2, 4 or 8 h at 10 degrees C. The solutions used, listed in order from an intracellular to an extracellular-like composition, were: University of Wisconsin (UW), Euro-Collins (EC), HTK-Bretschneider (HTK), reversed St. Thomas' Hospital (ST2) and Krebs-Henseleit (KH). After cold storage, the muscles were tested by direct electrical stimulation to obtain the maximum twitch tension (Pt) and the maximum tetanus tension (P0). Subsequently, the muscles were prepared for morphological analysis. 3. In general, storage at 10 degrees C caused a gradual decrease of Pt and P0 with time. After 8 h of storage in the extracellular-like solutions KH and ST2, the P0 was about 50% (SOL) and 35% (CT) of control. Eight hours of storage in intracellular-like solutions resulted in a P0 of 50% of control for HTK, in a P0 of 40% (SOL) and 67% (CT) for UW, but in a P0 of 5% (SOL) and 26% (CT) for EC. These findings corresponded well with the morphological observations. 4. It is concluded that the effects of 10 degrees C storage on skeletal muscle function are not predominantly determined by the intra- or extracellular-like composition of the solutions used. Both UW and HTK were most effective (P0 > 50% of control) in preserving muscle function.
Animals↗
Electrically stimulated free-flap graciloplasty for urinary sphincter reconstruction: a new surgical procedure.
In electrically stimulated (dynamic) graciloplasty for urinary incontinence, the gracilis muscle is transposed into the pelvis, and the distal part is used to reconstruct a neosphincter. Clinical outcomes using this technique have been disappointing due to stricture of the urethra caused by ischemia in the distal part of the gracilis and limited gracilis length available for neosphincter construction. Furthermore, the urethra is twisted by the contracting gracilis, rather than circumferentially squeezed. The purpose of the present study was to test the anatomical and functional feasibility of a new surgical approach to reconstruct a urinary sphincter, using the gracilis muscle as a free flap. In 12 human cadavers, the anatomical feasibility for creating a neosphincter by using the gracilis free flap was determined. In all cases, transfer of the gracilis muscle into the pelvis as a free flap (with the nerve intact) was feasible, and ample muscle was available to construct a neosphincter around the bladder neck. Gracilis neosphincter function was studied in seven dogs. The left gracilis muscle was subjected to transfer into the pelvis as an innervated free flap to create a neosphincter around the urethra. The right (control) gracilis muscle was lifted as a single pedicle flap, remained in situ, and was wrapped around a stent to mimic the urethra. Function (expressed as peak pressure generation and fatigue rate) and surface perfusion were determined for all gracilis muscles. In each dog, both sides were compared using the paired Student's t test for statistical analysis, and no significant difference was measured for the two groups. In conclusion, an innervated gracilis free flap can be used to create a neosphincter around the bladder neck. In an acute study in dogs, function and perfusion of the innervated gracilis free flap are not compromised.
Animals↗
The prepuce free flap: dissection feasibility study and clinical application of a super-thin new flap.
The aim of this study was to develop a free flap of the male prepuce. First, a dissection feasibility study was performed in eight male cadavers. Dissection proved feasible, and the mean surface area of the prepuce, when folded out, was 46.7 cm2. The mean pedicle length was 15 cm, with a mean diameter of the inferior external pudendal artery at its origin of 1.2 mm and a mean diameter of the inferior external pudendal vein at its origin of 1.9 mm. Next, a viability study was performed by isolating a prepuce free flap during male-to-female sex reassignment procedures. The flap as well as the residual skin of the penis shaft remained well perfused. Thereafter, the new prepuce free flap was successfully applied for the reconstruction of defects of the floor of the mouth, tongue, and oropharynx in two patients. The thinness and pliability of the flap, its large surface area, the long vascular pedicle, and the limited donor-site morbidity are the major advantages of this new flap. The possibility to raise the flap simultaneously with the tumor resection is an additional advantage. The small caliber of the flap artery seems to be the only drawback.
Aged↗
Neurotmesis of the lateral femoral cutaneous nerve when coring for iliac crest bone grafts.
Two patients are presented suffering from meralgia paresthetica, owing to neurotmesis of the lateral femoral cutaneous nerve following bone-graft harvesting from the iliac crest with a cylindrical osteotome. Despite this donor-site complication, the advantages of a coring technique as compared with traditional bone-graft harvesting techniques are numerous: better cosmetic results, less pain, no need for general anesthesia, shorter hospitalization, and a minimum of donor-site morbidity. Also, this technique has proven itself easy and effective. To minimize donor-site morbidity, some clinical recommendations to avoid neurotmesis are given with regard to the anatomy and anatomic variations of the lateral femoral cutaneous nerve.
Adult↗
The use of silicone occlusive sheeting (Sil-K) and silicone occlusive gel (Epiderm) in the prevention of hypertrophic scar formation.
The development of hypertrophic scars and keloids is an unsolved problem in the process of wound healing. For this reason, a successful treatment to prevent excessive scar formation still has not been found. Over the last decade, however, a promising new treatment has been introduced. Silicone materials have proved to reduce the amount of scar tissue and are believed even to prevent hypertrophic scar and keloid formation. In this study, the prophylactic effect of a silicone occlusive sheeting (Sil-K, Degania, Israel) and a silicone occlusive gel (Epiderm, Inamed B.V., The Netherlands) was investigated in a bilateral breast-reduction scar model in which the nontreated scars were supported by nonocclusive Micropore (3M, The Netherlands). The inframammary scars of 129 female patients with a mean age of 31 years ( 14 to 69 years) were studied up to 1 year after the operation. The width and height were measured, and B-scan ultrasound, laser-Doppler flowmetry, and color measurements were used as objective indicators to distinguish between normal and exuberant scars. Three months following the operation, 64.3 percent of the patients developed a hypertrophic scar, which was reduced to 56.6 percent after 6 months and down to 35.3 percent after 1 year. No keloids were seen. Patients with an easily tanning skin, nonsmokers, and patients with an allergy showed more hypertrophic scar formation. Neither Sil-K, used in 68 patients, nor Epiderm, used in 61 patients, could prevent the formation of hypertrophic scars. If both groups were taken together, the scars treated with silicone materials even developed significantly more hypertrophy compared with the Micropore-applicated scars.
Adolescent↗
Development of calcium phosphate cement for rapid crystallization to apatite.
The purpose of this study was to develop an alpha-tricalcium phosphate (alpha-TCP) cement which transforms to hydroxyapatite (HAP) in a relatively short period. We used calcium and phosphate solutions as the liquid phase for the alpha-TCP cement. The alpha-TCP powder was first mixed with CaCl2 solution, and then mixed with NaH2PO4 or Na2HPO3 solution for a total powder/liquid ratio of 1.8. The setting time became shorter with the increase in the concentration of calcium and phosphate solutions, reaching 5 min, whereas the setting time was longer than 30 min when distilled water was used as the liquid phase. X-ray diffraction analysis revealed that the cement was mostly transformed to HAP within 24 h when kept in an incubator. We concluded that alpha-TCP should be mixed with calcium and phosphate solutions since this results in a moderate setting time and fast transformation to HAP even if the method of mixing becomes a little complex.
Calcium Phosphates↗
Estimation of residual stress in dental porcelain by laser-Raman spectroscopy.
Residual stress in the surface of dental porcelain was estimated using laser Raman spectroscopy. Sixteen different magnitudes of residual stress were generated in commercial porcelain disks by tempering, ion exchange, and slow cooling. The specimens were analyzed using a laser-Raman spectrometer with an Ar+ laser. The Raman shift of the largest peak near 500 cm-1 originating from silica was used as an indicator of the level of residual stress. For comparison, the residual stress in the specimen was estimated by the indentation micro-fracture method. The Raman shift of the porcelain increased with increasing residual stress at 3.7 x 10(-2) cm-1/MPa (R2 = 0.89). The increase in the Raman shift corresponded to the increase in compressive stress. In addition, the value of full width at half maximum on the peak corresponded to the residual stress (-1.57 x 10(-1) cm-1/MPa: R2 = 0.82). These results revealed that the increase of residual stress in porcelain clearly appears on the Raman spectrum as an increase in the Raman shift. It is thus feasible to estimate residual stress in porcelain by laser-Raman spectroscopy.
Aluminum Silicates↗
Tissue response to fast-setting calcium phosphate cement in bone.
Fast-setting calcium phosphate cement (FSCPC) is a promising new bioactive cement with a significantly short setting time (approximately 5-6 min) compared to conventional calcium phosphate cement (c-CPC) (30-60 min) at physiologic temperatures. As a result of its ability to set quickly, it is applicable in surgical procedures where fast setting is required. In this study, FSCPC was implanted in rat tibiae to evaluate tissue response and biocompatibility. FSCPC was converted to hydroxyapatite (HAP) in bone faster than c-CPC in the first 6 h. By 24 h, significant amounts of both FSCPC and c-CPC had been converted to HAP. The conversion of FSCPC into HAP further proceeded gradually, reaching 100% within 8 weeks. Infrared spectroscopic analysis disclosed the deposition of B-type carbonate apatite, which is a biological apatite contained in human dentin or bone, on the surface of the FSCPC. Histologically, FSCPC showed a tissue response similar to that of c-CPC. A slight inflammatory reaction was observed in the soft tissue apposed to both cements in the early period, and new bone was formed along the surface of the FSCPC at the adjacent bone. However, no resorption of either cement by osteoclasts or macrophages was observed within 8 weeks. We conclude that FSCPC is superior to c-CPC in clinical applications in oral and maxillofacial, orthopedic, plastic, and reconstructive surgery, since it shows a faster setting time and higher mechanical strength in the early period that are required in these surgical procedures, as well as osteoconductivity and excellent biocompatibility similar to that of c-CPC.
Animals↗
Non-decay type fast-setting calcium phosphate cement: hydroxyapatite putty containing an increased amount of sodium alginate.
A hydroxyapatite [(HAP) Ca10(PO4)6(OH)2] putty that behaves like a putty or self-curing resin was made by increasing the amount of sodium alginate in non-decay type fast-setting calcium phosphate cement (nd-FSCPC). nd-FSCPC became viscous as the sodium alginate concentration was increased. The best handling properties were obtained when nd-FSCPC contained 8% sodium alginate in its liquid phase. When a 2-kg glass plate was placed on the paste, HAP putty spread to form an area three times that of FSCPC paste. Thus, HAP putty is expected to be easier to use than FSCPC in the filling of bone defects. HAP putty did not decay; in fact, it set within approximately 20 min when immersed in distilled water immediately after mixing. The wet diametral tensile strength value of HAP putty was approximately 12 MPa after 24 h, the same as that for nd-FSCPC containing 0.5% sodium alginate in its liquid phase, or FSCPC that is free from sodium alginate. The elements constituting set HAP putty were examined using powder X-ray diffraction and found to be predominantly apatitic minerals after 24 h. Since the handling properties of a putty or self-curing resin-like cement are very useful in certain surgical procedures, HAP putty made by increasing the sodium alginate concentration in nd-FSCPC is potentially a valuable new biomaterial for use in plastic and reconstructive surgery, as well as oral and maxillofacial surgery.
Alginates↗
[Iatrogenic cicatricial endometriosis].
A woman aged 36, who two years previously had undergone a caesarean section, developed a painful swelling of the scar attributed to cicatricial endometriosis. This is a rare disorder brought about by peroperative displacement of normally or ectopically situated uterine mucous membrane to the surgical wound. There, it may proliferate and cause characteristic signs and symptoms that are simple to diagnose: cyclic pain, swellings and sometimes, bleedings. Pharmaceutical, possible hormonal treatment is of limited value, because cessation of the medication is frequently followed by recurrences. Consequently, ample surgical excision in endometriosis is to be preferred; this is to be regarded as a curative therapy.
Abdominal Muscles↗
Surface modifications of titanium in calcium-ion-containing solutions.
The surface of titanium was modified in calcium-ion-containing solutions to improve bone conductivity. Three kinds of aqueous solutions for the modification were prepared using calcium nitrate, calcium chloride, and calcium oxide. The pH values of the solutions were 3.9, 7.4, and 12.6, respectively. At first, anatase powder was immersed in the solutions of 7 days to confirm the effect of the solutions on the modification. As a result, calcium titanate was formed on the anatase powder, indicating that the titanium surface was possibly modified by the solutions. Titanium plates were then immersed in the solutions at ambient temperature for 7 days, washed by deionized water, and dried. X-ray photo-electron spectroscopy of surface-modified titanium revealed that the surface-modified layer contained calcium hydroxide and/or calcium titanate. The surface-modified layer in which titanium was modified was thickest in this order: calcium oxide, calcium chloride, and calcium nitrate solutions. Apatite was formed on the surface-modified titanium in Hanks' solution while apatite was undetected on unmodified titanium. Therefore, the surface modification of titanium may improve bone conductivity. The amount of apatite corresponded to the thickness of the surface-modified layer and the amount of calcium in the layer.
Apatites↗
Review of facilitated approaches to vascular anastomosis surgery.
BACKGROUND: There is an increasing demand for an easier, quicker, less damaging, but reliable procedure to create a vascular anastomosis. This demand is not new but is revitalized by the movement of vascular procedures in various specialties, including cardiac surgery, toward minimally invasive procedures. This article reviews the most important representatives of devices or methods that have been developed in the last two centuries. METHODS: A thorough literature search was performed. The outcome is presented and discussed in four parts: (1) stapling and clipping devices, (2) coupling devices, (3) glues, and (4) laser welding. RESULTS: Stapling devices have not become the standard fashion to create an anastomosis because they are too complicated to use. In selected cases clips have potential in vascular surgery. There is a ring-pin coupling system available that is easy to use and especially suitable for creating an end-to-end anastomosis. The ideal glue is yet to be developed, and the currently available laser welding techniques have to become refined. CONCLUSIONS: It is anticipated that the future lies in hybrid techniques that combine sutures or clips with glues or laser-welding techniques.
Anastomosis, Surgical↗
The role of suture material in hypertrophic scar formation: Monocryl vs. Vicryl-rapide.
The development of hypertrophic scars and keloids is an unsolved problem in the process of wound healing. There are indications that inflammation plays an important role in this process, but its exact mechanism remains unclear. In this study the amount of inflammation and the development of hypertrophic scars and keloids was investigated in inframammary skin incisions sutured with synthetic absorbable suture materials: a monofilamentous suture (Monocryl) compared with a multifilamentous suture (Vicryl-rapide). In 81 breast reduction patients Monocryl (N = 28) has proved to give significantly smaller, less reactive scars with a lower tendency toward hypertrophic scar formation compared with Vicryl-rapide (N = 53).
Abscess↗
Influence of modification of Na2O in a glass matrix on the strength of leucite-containing porcelains.
The desirable thermal properties of matrix glass to the strength of feldspar porcelain with leucite crystal were investigated. Five kinds of feldspar glasses, each with different a content of Na2O, were prepared for the matrix glasses of the leucite-containing porcelains. The specimens were arranged by mixing each glass powder with high-purity natural leucite crystals (0, 20 and 40%) followed by firing. The thermal properties of the glass and the transformation temperature of the leucite were measured. A three-point bending test was performed to measure the flexural strength of the porcelains. The glass transition temperature and deformation temperature of the glass-only porcelains were decreased as the Na2O content increased. The Na2O-modified glasses were substantially strengthened by the leucite dispersion. However, the strength of the porcelains was affected by the relation between the transformation temperature of the leucite and the thermal properties of the glass matrix. It was concluded that control of the residual stress in the composite porcelain is an important factor in developing high strength porcelain containing leucite.
Aluminum Silicates↗