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PubMed1995

[Surgical abdominal access for prolapse using a Vicryl composite lattice. Preliminary study].

OBJECTIVE: Promontory fixation is a reliable technique for genitourinary prolapsus. Results obtained with Mersurtures are good, but infectious episodes have been described and the fixation is rigid. The pelvic organs loose their mobility with possible functional impairment. To avoid these problems, we tested a composite implant composed of 60% absorbable polyglactine 910 (Vicryl) and 40% non-absorbable terephthalic polyester (Dacron). SUBJECTS AND METHODS: A series of 32 patients with genito-urinary prolapsus were treated by one operator using the new material. Promontory fixation was performed in all cases, with at least one implant. The patients were followed for mean 24.2 months for evaluation of tolerance to the new material and the functional impact. These parameters were compared retrospectively with former experience with Mersutures. RESULTS: The new material was perfectly tolerated and no infectious complication was observed. The anatomic results were identical to those obtained with the Mersutures, giving 93.4% good anatomic results, 68% cure rate for urinary incontinence and 20% major improvement in urinary incontinence. It was difficult to analyse results for sexual activity and digestive tract function. CONCLUSION: The Vicryl composite is useful for promontory fixation in patients with prolapsus. This material which reduces the amount of inert material remaining in the form of a thin lattice of highly flexible Dacron, should be tested prospectively to determine the functional benefit of prolapsus care.

Adult↗
PubMed1980

Absorbable sutures (Dexon and Vicryl) in the corneolimbal incision. Used in lens implantation surgery.

In 115 consecutive cataract extractions with implantation of artificial lens a clinical evaluation of absorbable sutures--polyglactin (910) (Vicryl 7-0) and polyglycolic acid (Dexon 8-0)--in corneolimbal incision has been performed. The corneolimbal wounds were closed by continuous suture technique with one double loop knot at the 12 o'clock and 5-6 loops on each side of the 12 o'clock knot. The suture had disappeared after 8 weeks in 95% of the eyes. Two months after operation the visual acuity, the power of corneal astigmatism and astigmatic orientation remained unchanged in both the Vicryl and the Dexon sutured group. This provided effectuation of early full prescription of glasses. Most complications in this material were suture independent and appeared during the early postoperative period. In only one eye inadequate wound closure was noticed. Shallow anterior chamber and hypotonia of short duration occurred in 5 eyes. Four of these patients developed corneal dystrophy. In the Vicryl sutured group suture reactions took place in 87% of the eyes. With dexon suture no such reaction appeared. The use of absorbable sutures in corneolimbal incision technique implies several surgical advantages and is seemingly safe.

Absorption↗
PubMed2001

Biocompatibility evaluation of dura mater substitutes in an animal model.

Dura-Guard Dural Repair Patch, PRECLUDE Dura Substitute, and Codman ETHISORB Dura Patch were evaluated in a six-month dural tissue reaction study in rabbits. Bilateral craniotomy was followed by subdural implantation for each dura mater substitute. The surgical procedure for the sham control group was the same except that no material was implanted. Implantation of all of these dura mater substitutes for 28, 91, or 182 days post-implantation did not result in any deaths or clinical neurobehavioral abnormalities, changes in cerebrospinal fluid, or significant macroscopic changes at necropsy. However, histomorphologic evaluation of the implantation sites revealed some differences in the tissue response to these materials. For Dura-Guard Dural Repair Patch, a nonabsorbable material derived from bovine pericardium, the implantation site was characterized by fibrosis of the overlying area with islands of osseous metaplasia and adhesions to the brain surface. Over time, infiltrative fibrosis of the implant resulted in separation of the collagenous layers of the implant and compression of the underlying brain. Fibrosis of the overlying area that incorporated this material formed a 'replacement' dura mater. Adhesions to the brain surface observed initially were still present at six months post-implantation. Implantation of PRECLUDE Dura Substitute, a nonabsorbable material comprised of expanded polytetrafluoroethylene, resulted in virtually no early reaction, and few adhesions to the brain surface at any time period. Although this material was eventually incorporated by fibrosis, islands of osseous metaplasia were also observed in this 'replacement' dura mater. The tissue reaction to Codman ETHISORB Dura Patch, an absorbable material comprised of polyglactin 910 and polydioxanone, was generally characterized by low-grade granulomatous inflammation and initial adhesions to the brain surface. The three-dimensional structure of this implant acted as a scaffold to guide the development and integration of a 'replacement' dura mater. The absorption of the material was associated with complete resolution of the inflammatory reaction, a lack of cerebral adhesions, and restoration of the normal architecture of this region. In conclusion, subdural implantation of Dura-Guard Dural Repair Patch, PRECLUDE Dura Substitute, or Codman ETHISORB Dura Patch in rabbits for up to six months resulted in the eventual restoration of the dura mater without significant adverse effects. However, osseous metaplasia associated with nonabsorbable Dura-Guard Dural Repair Patch and PRECLUDE Dura Substitute, and the infiltration of Dura-Guard Dural Repair Patch by fibrosis suggests that long-term follow-up may be needed after the use of these materials in patients. An advantage of Codman ETHISORB Dura Patch was that it was completely absorbed after guiding the restoration of the dura mater without any morphological sequelae.

Absorbable Implants↗
PubMed1988

Derivation of neointima in vascular grafts.

Vascular prostheses woven from absorbable lactide/glycolide copolymers are replaced by myofibroblast-laden tissue conduits lined by endothelium. When these prostheses are implanted in arteries of animal models, the absorption-replacement reactions are inhibited by Dacron. To determine whether these reactions resulted primarily from transanastomotic pannus ingrowth, prostheses (30 mm x 4 mm) were constructed of three 10-mm long segments with Dacron segments on both ends and a middle polyglactin 910 (PG910) segment. The prostheses were implanted in the aortas of 15 adult New Zealand White rabbits. Resultant prosthesis/tissue complexes were harvested in triplicate at 2 weeks and at 1, 2, 3, and 4 months after implantation. Explants were photographed and sectioned for light microscopy and for scanning and transmission electron microscopy, which showed 100% patency with no aneurysms or stenoses. Inner-capsule thickness in the PG910 segments increased only during the interval from 2 weeks to 2 months; this thickness was statistically greater than either Dacron segment at 1 and 2 months (p less than or equal to 0.004 and p less than or equal to 0.0001, respectively). Proximal and distal Dacron segments did not differ from each other in thickness. Inner capsules of PG910 segments at 1 month were composed predominantly of myofibroblasts, whereas inner capsules of Dacron segments were composed of fibrin coagulum beyond the initial 2 mm of endothelial pannus ingrowth. These data suggest that transanastomotic pannus ingrowth is not the primary source of cells replacing absorbable vascular prostheses.

Absorption↗
PubMedDate not supplied

Development and characterisation of silver-doped bioactive glass-coated sutures for tissue engineering and wound healing applications.

A novel silver-doped bioactive glass powder (AgBG) was used to coat resorbable Vicryl (polyglactin 910) and non-resorbable Mersilk surgical sutures, thereby imparting bioactive, antimicrobial and bactericidal properties to the sutures. Stable and homogeneous coatings on the surface of the sutures were achieved using an optimised aqueous slurry-dipping technique. Dynamic mechanical analysis (DMA) was used to investigate the viscoelastic parameters of storage modulus and tandelta and thermal transitions of the as-received and composite (coated) sutures. The results generally showed that the bioactive glass coating did not affect the dynamic mechanical and thermal properties of the sutures. The in vitro bioactivity of the sutures was tested by immersion in simulated body fluid (SBF). After only 3 days of immersion in SBF, bonelike hydroxyapatite formed on the coated suture surfaces, indicating their enhanced bioactive behaviour. Resorbable sutures with bioactive coatings as fabricated here, in conjunction with 3-D textile technology, may provide attractive materials for producing 3-D scaffolds with controlled porosities for tissue engineering applications. The bactericidal properties imparted by the Ag-containing glass coating open also new opportunities for use of the composite sutures in wound healing and body wall repair.

Absorbable Implants↗
PubMed1988

Selective cell transplantation using bioabsorbable artificial polymers as matrices.

To date, selective cell transplantation has involved injecting cell suspensions into tissues or the vascular system. This study describes attaching cell preparations to bioerodable artificial polymers in cell culture and then implanting this polymer-cell scaffold into animals. Using standard techniques of cell harvest, single cells and clusters of fetal and adult rat and mouse hepatocytes, pancreatic islet cells, and small intestinal cells have been seeded onto biodegradable polymers of polyglactin 910, polyanhydrides, and polyorthoester. Sixty-five fetuses and 14 adult animals served as donors. One hundred fifteen polymer scaffolds were implanted into 70 recipient animals: 66 seeded with hepatocytes; 23 with intestinal cells and clusters; and 26 with pancreatic islet preparations. The cells remained viable in culture, and in the case of fetal intestine and fetal hepatocytes, appeared to proliferate while on the polymer. After four days in culture, the cell-polymer scaffolds were implanted into host animals, either in the omentum, the interscapular fat pad, or the mesentery. In three cases of fetal intestinal implantation coupled with partial hepatectomy, successful engraftment occurred in the omentum, one forming a visible 6.0 mm cyst. Three cases of hepatocyte implantation, one using adult cells and two using fetal cells, have also engrafted, showing viability of hepatocytes, mitotic figures, and vascularization of the cell mass. To date, no pancreatic islets have survived implantation. This method of cell transplantation, which we have termed "chimeric neomorphogenesis," is an alternative to current methods and requires further study.

Animals↗
PubMed1981

Absorbable or nonabsorbable suture materials for closure of the dura mater?

This study was undertaken to determine which suture material would give the best results for closure of the dura mater. Because there is no need for the suture to remain longer than until healing has occurred and as remaining foreign material will predispose to foreign body reactions and infection, it was considered important to test new absorbable materials like polyglactin 910 (Vicryl) and polyglycolic acid (Dexon) for closure of the dura mater. The reactions from these materials were compared to those of silk and polyester (Ethibond) in dogs 60 days after the suture of dural incisions. The quality of healing with respect to the smoothness of the subdural surface, the presence of adhesions between sutures and the brain surface, the degree of absorption of the material, and reactions around the sutures were evaluated. Vicryl gave the best results, providing a smooth subdural surface without adhesions. It was almost totally absorbed when healing was completed, in contrast to Dexon and the other materials. The cellular reaction around Vicryl was slight. Silk, Ethibond, and Dexon protruded from the subdural surface and adhesions to the arachnoid were common. When the dura mater was removed, these adhesions tore off the leptomeninges with their vascular supply to the cortex. The results of these experiments seem to justify the recommendation of Vicryl for suturing of the dura mater. Such an absorbable material decreases the risk of foreign body reactions, and infections will be more easily combated because of the absence of foreign material. The lack of subdural adhesions is an advantage if reoperation is necessary.

Absorption↗
PubMed1989

Macrophage/biomaterial interactions: the stimulation of endothelialization.

This current study analyzed macrophage/biomaterial interactions as modulators of endothelial cell proliferation. Rabbit peritoneal macrophages were harvested and seeded (1 x 10(6) cells/ml) into culture flasks with Dulbecco's modified Eagle medium and 10% platelet-poor, plasma-derived equine serum. Macrophages were identified by morphologic characteristics, nonspecific esterase, and Fc (immunoglobulin G) receptors on the cell membranes. Culture conditions were (1) no prosthetic material, (2) Dacron, or (3) Polyglactin 910 (PG910) (Ethicon, Inc., Somerville, N.J.). Both prosthetic materials were finely shredded into the media. After 5 weeks in culture, PG910 inclusions were seen within macrophage cytoplasm. No intracytoplasmic Dacron was observed. Conditioned media from all three groups were collected weekly from week 5 to week 10, centrifuged, filtered, and added in serial dilutions to cultured quiescent murine capillary lung endothelial cells. Quiescence was achieved by serum deprivation and verified by [3H]thymidine incorporation. Sixteen hours after addition of conditioned media, [3H]thymidine was measured in and expressed as percent increase above quiescent levels. Mitogenic activity in the PG910 group progressively increased from weeks 6 to 10. At week 10, the PG910 group (1:10 dilution) yielded a 620% increase in DNA synthesis. The Dacron group never varied from the control group (no prosthetic). The mean increases in [3H]thymidine incorporations over weeks 7 to 10 were PG910, 540% +/- 65%; Dacron, 323% +/- 65%, and control, 343% +/- 26% (PG910 vs Dacron, p less than or equal to 0.004). These studies suggest macrophage activation by bioresorbable prostheses, yielding growth factor release with subsequent enhanced endothelial cell proliferation.

Animals↗
PubMed1999

A new variety of hydroxyapatite: the Chinese implant.

PURPOSE: This study was designed to evaluate a new type of hydroxyapatite (HA) implant (produced in China) in a rabbit model. METHODS: Three New Zealand white rabbits underwent enucleation of one eye followed by implantation of a 12-mm Chinese HA implant wrapped in Vicryl mesh (polyglactin 910). Magnetic resonance imaging was performed to assess host fibrovascularization of the implant 4, 8, and 12 weeks after implantation. One animal was sacrificed at each of these times for histopathologic examination. The Chinese implant was also examined chemically and by scanning electron microscopy. It was compared to the original BioEye and the third generation synthetic HA implant produced in France by FCI (FCI3). RESULTS: This new variety of HA implant from China is heavier than the FCI3 implant but lighter than the original BioEye. The Chinese implant was easy to work with and not fragile. The pore size was more uniform than the FCI3 implant and similar to the BioEye implant clinically and by scanning electron microscopy. The pores in this implant are unidirectional. Analysis for impurities revealed a calcium oxide (CaO) content of 4.4%. Histopathologically, central vascularization occurred by 4 weeks and was similar in extent to the vascularization seen with the FCI3 implant and the BioEye. CONCLUSIONS: The Chinese implant is less expensive then the BioEye and the FCI3 implants, and appears to be a viable alternative to the BioEye. Further refinements are in progress to eliminate the CaO contaminant.

Animals↗
PubMed2005

Thermal Characterizations of silver-containing bioactive glass-coated Sutures.

This study utilized and compared a number of thermal analysis methods to characterize the thermal properties of commercial sutures with and without antimicrobial coatings of silver-doped bioactive glass (AgBG) interlocking particulates. The effect of a slurry dipping technique used to coat resorbable Vicryl (polyglactin 910) and non-resorbable Mersilk surgical sutures with AgBG was investigated using conventional differential scanning calorimetry (DSC), high speed calorimetry (or HYPERDSC), and modulated temperature DSC (MTDSC). These methods were compared in terms of their ability to resolve the thermal transitions of the types of suture materials. Differential thermal analysis (DTA) and thermogravimetric analysis (TGA) were used to verify the thermal degradation temperatures of these materials and to quantify the AgBG coatings on the sutures. The use of complementary thermal analysis techniques enabled the understanding of the effect of the AgBG coating technique on the morphological properties of the sutures. The slurry dipping technique had no significant effect on the thermal transitions of both types of materials. The use of high speed calorimetry through DSC offered better resolution for the transitions that appeared to be weak through conventional heating regimes, and was able to separate broad double transitions. Furthermore, it was shown not to compromise either the melting temperature or the enthalpy of melting. Therefore this method allows for the accurate determination of thermal transitions through much shorter experimental times thus allowing for an increased sample throughput. The combined DTA and TGA indicated that a greater AgBG coating was obtained in the case of the Mersilk sutures.

Coated Materials, Biocompatible↗
PubMed1988

Polyglactin 910/polydioxanone bicomponent totally resorbable vascular prostheses.

Previous studies from our laboratory have shown that bioresorbable vascular prostheses woven from lactide-glycolide copolymers and implanted into arteries of several animal models become replaced by cellular tissues; the rate of replacement parallels the kinetics of prosthetic resorption. This study evaluates the efficacy of bicomponent resorbable prostheses as a method of augmenting resistance to dilatation during the resorption period of the more rapidly resorbed component. Bicomponent prostheses (n = 37) were woven from compound yarns containing 74% polyglactin 910 (PG910) and 26% polydioxanone (PDS) and were interposed into adult white New Zealand rabbit infrarenal aortas. Resultant prosthesis-tissue complexes were harvested after 2 weeks to 12 months. Specimens were photographed and sectioned for light, scanning, and transmission electron microscopy. Randomly selected fresh explants at 1 and 3 months and control aortic segments from the same rabbits were simultaneously perfused with culture media (37 degrees C, 100/80 mm Hg, 60 ml/min) and perfusates assayed by means of tritiated radioimmunoassay techniques for the stable prostacyclin metabolite 6-keto-PGF1 alpha before and after the addition of sodium arachidonate (10 micrograms/ml) to the media. Results showed 100% patency, no aneurysms, and stenosis in 1 of 37 prostheses (3%). PG910 was totally resorbed by 2 months and PDS by 6 months. By 1 month inner capsule thickness was 303 +/- 30 microns. In contrast to previous reports this was significantly thicker than that within 100% PDS (230 +/- 40 microns) and significantly less thick than in 100% PG910 (530 +/- 62 microns). Inner capsules in all three groups stabilized at similar thicknesses (417 to 502 microns).(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed2006

Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. III. Class II furcations after 10 years.

BACKGROUND: The aim of this 10-year follow-up was to evaluate the long-term results after guided tissue regeneration (GTR) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers clinically. METHODS: In nine patients with advanced periodontitis, nine pairs of contralateral Class II furcation defects were treated. Within each patient, one defect received a non-resorbable expanded polytetrafluoroethylene barrier (ePTFE; C) and the other a bioabsorbable (polyglactin 910; T) barrier by random assignment. At baseline and 12 and 120 +/- 6 months after surgery, clinical parameters were obtained. RESULTS: Twelve and 120 months after GTR therapy, statistically significant (P <0.05) horizontal clinical attachment level (CAL-H) gain was observed in both groups (C12: 1.9 +/- 0.5 mm; C120: 1.1 +/- 1.3 mm; T12: 1.9 +/- 0.8 mm; T120: 1.7 +/- 1.4 mm). However, one patient with furcations that had been assessed as Class I 12 months after GTR therapy had lost two teeth after 10 years, and another patient had lost more than 2 mm CAL-H at one furcation from 12 to 120 +/- 6 months post-surgery 10 years after implantation of an ePTFE barrier. Horizontal bone sounding revealed similar bone gain in both groups 120 +/- 6 months post-surgery (C120: 0.8 +/- 1.0 mm; T120: 1.1 +/- 1.1 mm). CONCLUSIONS: CAL-H gain achieved after GTR therapy in Class II furcations was stable after 10 years in 15 of 18 defects (83%). The study failed to show a statistically significant difference in stability of CAL-H gain between group C and T 10 years after GTR therapy.

Absorbable Implants↗
PubMed1988

Substitution of the wall of the trachea by absorbable synthetic material.

Synthetic, absorbable tissue proved to supply a valuable "interim support" for an orderly reconstruction of the wall of the trachea during the first three months following surgery. This is in general the result of experiments in which the use of implanted Polyglactin 910 as a substitute material for the tracheal wall of rats and rabbits was tested. Additionally the possibilities for satisfactory stabilization of the tracheal wall by means of Polydioxanon, another synthetic substance, which is absorbed more slowly, were investigated. The experiments were performed in a total of 30 rats and 70 rabbits. Initial attempts to substitute the entire circumference of the tracheal wall in the area of the neck by synthetics resulted in excessive difficulties post-surgically. Frequently substantial stenoses, obstructing respiration, developed. Consequently, patches of substitute material, covering more than half of the circumference of the trachea, were applied. The periods of survival of the animals ranged from one to 23 weeks. Following autopsy and macroscopical inspection, selected specimens were examined histologically by means of light microscopes and scanning electron microscopes. Evaluation of the samples showed progressive lining of the inner surface of the prosthetic patches with connective tissue and subsequent covering with squamous cell epithelium. On the average, approximately six weeks after surgery, ciliated columnar epithelium resembling normal respiratory mucosa developed. Gradually the synthetic fabric was replaced by dense connective tissue, which finally contained newly generated hyaline cartilage also. The very slow rate of dissolution of the polydioxanone material provided sufficient time for the formation of a new, stratified wall of the trachea, maintaining sufficient clearance in the tracheal lumen.

Animals↗
PubMed2003

Composite surgical sutures with bioactive glass coating.

A processing method was developed to coat polyglactin 910 (Vicryl) sutures with bioactive glass powder (45S5 Bioglass). High reproducibility and homogeneity of the coating in terms of microstructure and thickness along the suture length were achieved. Bioglass-coated sutures exhibited a high level of chemical reactivity in simulated body fluid (SBF), indicating their bioactive behavior. This was evident by the prompt formation of hydroxyapatite (HA) crystals on the surface after only 7 days of immersion in SBF. These crystals grew to form a thick HA layer (15 microm thickness) after 3 weeks in SBF. The tensile strength of the sutures was tested before and after immersion in SBF in order to assess the effect of the bioactive glass coating on suture degradation. The tensile strength of composite sutures was lower than that of as-received Vicryl sutures, 385 and 467 MPa, respectively. However, after 28 days of immersion in SBF the residual tensile strengths of coated and uncoated sutures were similar (83 and 88 MPa, respectively), indicating no negative effect of the HA layer formation on the suture strength. The effect of bioactive glass coating on the polymer degradation is discussed. The developed bioactive sutures represent interesting materials for applications in wound healing, fabrication of fibrous three-dimensional scaffolds for tissue engineering, and reinforcement elements for calcium-phosphate temporary implants.

Body Fluids↗
PubMed2003

Staged management of giant abdominal wall defects: acute and long-term results.

INTRODUCTION: Shock resuscitation leads to visceral edema often precluding abdominal wall closure. We have developed a staged approach encompassing acute management through definitive abdominal wall reconstruction. The purpose of this report is to analyze our experience with this technique applied to the treatment of patients with open abdomen and giant abdominal wall defects. METHODS: Our management scheme for giant abdominal wall defects consists of 3 stages: stage I, absorbable mesh insertion for temporary closure (if edema quickly resolves within 3-5 days, the mesh is gradually pleated, allowing delayed fascial closure); stage II, absorbable mesh removal in patients without edema resolution (2-3 weeks after insertion to allow for granulation and fixation of viscera) and formation of the planned ventral hernia with either split thickness skin graft or full thickness skin closure over the viscera; and stage III, definitive reconstruction after 6-12 months (allowing for inflammation and dense adhesion resolution) by using the modified components separation technique. Consecutive patients from 1993 to 2001 at a single institution were evaluated. Outcomes were analyzed by management stage, with emphasis on wound related morbidity and mortality, and fistula and recurrent hernia rates. RESULTS: Two hundred seventy four patients (35 with sepsis, 239 with hemorrhagic shock) were managed. There were 212 males (77%), and mean age was 37 (range, 12-88). The average size of the defects was 20 x 30 cm. In the stage I group, 108 died (92% of all deaths) because of shock. The remaining 166 had temporary closure with polyglactin 910 woven absorbable mesh. As visceral edema resolved, bedside pleating of the absorbable mesh allowed delayed fascial closure in 37 patients (22%). In the stage II group, 9 died (8% of all deaths) from multiple organ failure associated with their underlying disease process, and 96% of the remaining 120 had split-thickness skin graft placed over the viscera. No wound related mortality occurred. There were a total of 14 fistulae (5% of total, 8% of survivors). In the stage III group, to date, 73 of the 120 have had definitive abdominal wall reconstruction using the modified components separation technique. There were no deaths. Mean follow-up was 24 months, (range 2-60). Recurrent hernias developed in 4 of these patients (5%). CONCLUSIONS: The staged management of patients with giant abdominal wall defects without the use of permanent mesh results in a safe and consistent approach for both initial and definitive management with low morbidity and no technique-related mortality. Absorbable mesh provides effective temporary abdominal wall defect coverage with a low fistula rate. Because of the low recurrent hernia rate and avoidance of permanent mesh, the components separation technique is the procedure of choice for definitive abdominal wall reconstruction.

Abdominal Injuries↗
PubMed1990

Growth of tracheal anastomoses in lambs. Comparison of PDS and Vicryl suture material and interrupted and continuous techniques.

Tracheal anastomoses were performed in 19 lambs (mean age 4 weeks, mean weight 9.8 kg) to compare polydioxanone (PDS) and polyglactin 910 (Vicryl) suture material (Ethicon, Inc., Somerville, N.J.) and simple continuous and simple interrupted suture technique. Each animal had two anastomoses with full-thickness bites for both suture techniques. Animals were killed at 4 months (n = 6) or 8 months (n = 5). Eight animals died before they were scheduled to be put to death (mean 6 weeks postoperatively). Transverse sections of the trachea were taken at the level of the anastomoses and three tracheal rings above and below each anastomosis. The cross-sectional area of the tracheal lumen of these transverse sections was measured with a computerized digitizing tablet. A percent luminal area for each anastomosis was calculated relative to the mean tracheal area three rings above and three rings below the anastomosis. There was little difference between interrupted and continuous technique with either suture material (p = 0.94). In 10 animals that each served as its own control for suture material, PDS anastomotic area was 55.0% +/- 4.1% of mean tracheal luminal area compared with 45.4% +/- 7.1% for Vicryl anastomoses (p = 0.06). Histologic analysis revealed a more intense inflammatory reaction surrounding multifilament Vicryl sutures with more rapid resorption and greater subsequent fibrosis relative to the reaction seen with PDS sutures. A small clinical experience with seven infants has confirmed short-term satisfactory clinical performance of continuous PDS suture for tracheal anastomosis.

Anastomosis, Surgical↗
PubMed1999

Prevention of Frey syndrome during parotidectomy.

OBJECTIVE: To evaluate the incidence of Frey syndrome (auriculotemporal nerve syndrome) after parotidectomy with and without placement of a subcutaneous implant and to examine the relationship between different implants and postoperative wound complications (hematoma, seroma, salivary fistula). DESIGN: A prospective nonrandomized controlled trial. SETTING: A primary care and referral university hospital center. PATIENTS: All patients scheduled for parotidectomy from April 1994 through August 1998 were eligible. Seventy patients were enrolled (2 refused). All 70 patients were evaluated for wound complications. Sixty patients with a follow-up of more than 1 year were evaluated for Frey syndrome. INTERVENTION: The choice of implant was left to the individual surgeon: 24 patients had no implant; 7, lyophilized dura implant; 7, polyglactin 910-polydioxanone (Ethisorb) implant; and 32, expanded polytetrafluoroethylene (e-PTFE) implant. OUTCOME MEASURES: The incidence of Frey syndrome was evaluated (1) subjectively by history (clinical Frey syndrome) and (2) objectively by using 2 newly developed tests. Both hemifaces were tested, with the normal side being used as a control. RESULTS: Clinical Frey syndrome was present in 12 patients: 11 without implants (11/24 [53%]) and 1 with an implant (1/46 [2%]) (P<.001). Objective tests were positive in 24 patients: 16 (76%) of 21 without implants and 8 (20%) of 39 with implants (P<.001). In the implanted patients, the objective tests were positive in 71% (5/7) of those with lyophilized dura, 14% (1/7) of those with Ethisorb, and 8% (2/29) of those with e-PTFE implants (P<.001). Wound complications included hematoma in 5 patients (7%), seroma in 4 patients (6%), and salivary fistula in 15 (21%). Salivary fistula occurred more frequently with Ethisorb (57%) and e-PTFE (25%) implants (P = .04). CONCLUSIONS: In patients without an implant, the incidence of Frey syndrome is 50% for subjective and 80% for objective evaluation. In patients with an implant, these incidences are 3% and 10%, respectively. Some implants are associated with a higher incidence of salivary fistula.

Adolescent↗
PubMed1991

Partially bioresorbable vascular grafts in dogs.

Previous studies have shown the effectiveness of partially resorbable arterial prostheses in the rabbit. This study compares these same compound prostheses with commercial graft materials in the dog. Conduits 4 mm inner diameter X 50 mm in length were woven from composite yarns containing 69% polyglactin 910 (PG910)/31% polypropylene or containing 70% polydioxanone/30% polypropylene. Nonresorbable controls were woven Dacron and expanded polytetrafluoroethylene (ePTFE). Baseline platelet aggregometry to 10(-5) mol/L adenosine diphosphate was performed. Seventy prostheses were implanted into the aorto-ilac positions, and the prosthesis/tissue complexes were harvested serially from 2 weeks to 1 year. Explanted specimens were photographed and fixed for light microscopy and for scanning and transmission electron microscopy. Results showed no aneurysms or perigraft hematomas. Overall patency for the PG910/polypropylene grafts was 18 of 20 (90%) and for polydioxanone/polypropylene was 19 of 22 (86%). For Dacron and ePTFE, 13 of 19 (68%) and 6 of 11 (54%) remained patent at time of explantation. The partially resorbable grafts, as a group, had significantly greater patency than the control grafts (p less than 0.03). Platelet aggregometry was not predictive of graft patency. Histologic analysis of the partially bioresorbable groups showed inner capsules (IC) composed of myofibroblasts and collagen beneath confluent endothelialized surfaces by 1 month. Kinetics of IC formation paralleled the rates of resorption of the resorbable components. IC cellularity and thickness were greater than those within Dacron or ePTFE. This study suggests an enhanced transinterstitial endothelial cell and myofibroblast ingrowth into the ICs of partially resorbable grafts and shows the effectiveness of these prostheses in the dog.

Absorption↗