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Laparoscopic cryptorchid castration in standing horses.

OBJECTIVE: This article describes a new technique for laparoscopic cryptorchid castration in standing horses. STUDY DESIGN: Prospective study. ANIMALS OR SAMPLE POPULATION: Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. METHODS: Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HCl (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted "L" pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. RESULTS: In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. CONCLUSIONS: The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. CLINICAL RELEVANCE: This approach will provide surgeons with another option to castrate cryptorchid stallions.

Anesthesia, General↗

Ex vivo strength comparison of bioabsorbable tendon plates and bioabsorbable suture in a 3-loop pulley pattern for repair of transected flexor tendons from horse cadavers.

OBJECTIVE: To test the failure strength and energy of 2 bioabsorbable implants applied to transected deep digital flexor tendons (DDFT) from adult horses. STUDY DESIGN: Ex vivo biomechanical experiment. SAMPLE POPULATION: Twelve pairs of deep digital flexor tendons harvested from the forelimbs of fresh equine cadavers. METHODS: Poly-L-lactic acid tendon plates were custom manufactured for application to the cylindrical surface of an adult equine deep digital flexor tendon. Twelve pairs of DDFTs were transected 2 cm distal to the insertion of the distal check ligament of the deep digital flexor tendon. One tendon of each pair was randomly selected for repair with a biodegradable plate or a 3-loop pulley method. Size 2 polydioxanone suture was used in both repairs. Repairs were tested in tension to failure, with peak force (PF) and total energy (TE) at repair failure recorded in Newtons (N) and Joules (J), respectively. A paired t-test was used for statistical evaluation with a significant level set at P< or = .05. RESULTS: Mean+/-SD PF for failure of plated tendons (1507.08+/-184.34 N) was significantly greater than for sutured tendons (460.86+/-60.93 N). TE was also significantly greater for failure of plated tendons versus sutured tendons. CONCLUSIONS: Plate fixation of transected cadaver DDFTs appear to have superior immediate failure strength than 3-loop pulley repairs. CLINICAL RELEVANCE: Whereas in vivo testing is required, a bioabsorbable tendon plate may provide initial increased strength to support tendon healing and decrease external coaptation requirements.

Absorbable Implants↗

Use of spider silk fibres as an innovative material in a biocompatible artificial nerve conduit.

Defects of peripheral nerves still represent a challenge for surgical nerve reconstruction. Recent studies concentrated on replacement by artificial nerve conduits from different synthetic or biological materials. In our study, we describe for the first time the use of spider silk fibres as a new material in nerve tissue engineering. Schwann cells (SC) were cultivated on spider silk fibres. Cells adhered quickly on the fibres compared to polydioxanone monofilaments (PDS). SC survival and proliferation was normal in Live/Dead assays. The silk fibres were ensheathed completely with cells. We developed composite nerve grafts of acellularized veins, spider silk fibres and SC diluted in matrigel. These artificial nerve grafts could be cultivated in vitro for one week. Histological analysis showed that the cells were vital and formed distinct columns along the silk fibres. In conclusion, our results show that artificial nerve grafts can be constructed successfully from spider silk, acellularized veins and SC mixed with matrigel.

Animals↗

Stabilisation of refraction following extracapsular cataract extraction.

Regular serial refraction was used to determine the rate of stabilisation of refraction following routine extracapsular cataract surgery in 85 eyes. Patients were divided into four groups depending on wound closure technique: limbal section closed by interrupted 8-0 virgin silk, 9-0 polydioxanone or 10-0 nylon sutures, and corneal section closed by continuous 10-0 nylon suture. Stabilisation of refraction, sufficient to prescribe satisfactory glasses, occurred at three months except in the interrupted 10-0 nylon group, when stabilisation was delayed to between four and five months. The factors affecting stabilisation and the causes of the differences observed are discussed.

Aged↗

Surgical treatment of dislocations of the acromioclavicular joint in the athlete.

The treatment of the sports related dislocation of the acromioclavicular joint remains controversial. This study was carried out to determine whether or not a combined surgical procedure consisting of repair and polydioxanone (PDS)-cord augmentation of the coracoclavicular ligaments, fixation of the acromioclavicular joint with a single Kirschner wire as well as the repair of the acromioclavicular ligament permitted return to athletic activity. Athletes were examined with regard to their range of motion, pain and their ability to return to the performance level achieved before the injury. During the period 1986-1989, 21 athletes were treated. Follow-up averaged 22 months. Return of athletes to previous performance level was related to their original degree of activity. Two recreational once-a-week athletes did not return to this level, 19 patients, including five competitive athletes, continued their previous activities. There was no correlation between coracoclavicular ossification or post-traumatic arthritis and a good or excellent result. We recommend the operative treatment of acromioclavicular separations in athletes.

Acromioclavicular Joint↗

Surgical ligation clip artifacts on CT scans.

Surgical ligation clips of various materials were scanned in a water-filled phantom to determine what artifacts would be produced. Tantalum clips produced severe image degradation, while stainless steel clips produced less severe degradation. Minimal artifacts were observed with titanium clips. Clips molded from an absorbable polymeric material, polydioxanone, were visible on computed tomography (CT) scans and had the least effect on the CT image.

Humans↗

Breaking strength of native and sutured trachea. An experimental study on sheep trachea.

Tracheal anastomoses are, even more so than other sutures, often only possible to prepare under tension and thus in danger of breakage. No information is available regarding native tracheae and freshly sutured tracheae. For this reason, our objective was to examine the tensile strength of native tracheae and compare it with freshly sutured specimens. Fresh tracheae were collected from the local slaughterhouse within 30 min of slaughter. With the help of a suitable holding device, 24 fresh tracheae were mounted on a material testing machine and stretched to breaking point, during which the force and distance required were recorded. The same study was carried out on each 10 freshly anastomosed tracheae using three different suturing techniques. The mean value of the maximum force required for native tracheae was 198 N. With continuous suturing (polypropylene), a mean value of 171 N was attained, and with single interrupted suturing (polydioxanone and polyglactin 910), 123 N, respectively, 108 N. Differences between the groups proved to be highly significant. With respect to the mechanical strain from traction, the continuous suture proved to be statistically identical to native tracheae, whereas single interrupted sutures revealed a considerably lower stability under burden. Therefore, the continuous suture is of advantage in respect of the mechanical strain from traction and the suture protection of tracheal anastomoses. Further studies with differing survival times in vivo with this method provide insight into the stability of tracheal anastomoses during the healing process.

Anastomosis, Surgical↗

Retropatellar chondromalacia associated with medial osteoarthritis after meniscus injury. One year of observations in sheep.

BACKGROUND/AIMS: In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated. METHODS: A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls). RESULTS: Retropatellar osteoarthritis in the non-sutured and sutured animals was intense in contrast to the control knees after 6 months in all groups (p < 0.001), and after 12 months in the PDS group (p < 0.001), LTS group and non-sutured animals (p < 0.05). CONCLUSION: Non-sutured meniscus tears and failed repair lead fast to intense PF osteoarthritis corresponding with tibial damage of the injured compartment.

Animals↗

Biomechanical evaluation of rotator cuff fixation methods.

Initial fixation strength and failure mode for various rotator cuff reattachment techniques (variations of the McLaughlin technique) were evaluated. Repair methods included standard suture (control), reinforced suture [expanded polytetrafluoroethylene (PTFE) patch and polydioxanone (PDS) tape augmentation] and stapling (nonarthroscopic and arthroscopic soft-tissue staples). The average strength of intact rotator cuff tissue (supraspinatus tendon) was also determined. The different rotator cuff repairs, including at least one control, were performed on fresh-frozen human cadaver shoulder pairs. Repairs were tested to failure in pure tension with the shoulder fixed in 60 degrees of abduction. Load and displacement data were normalized to controls, grouped according to failure modes, and statistically analyzed. The two basic failure modes observed were 1) bone failure, or suture tearing through the bone (indicating weak bone stock) and 2) tendon failure, or suture tearing of the rotator cuff. Gross comparisons between intact and repaired tendons indicated that the intact tendon was two to three times stronger than the repaired tendon. Based on the mode of failure and lack of increased strength after repair, the use of staples for cuff attachment is discouraged. PDS tape suture reinforcement did not increase fixation strength. In contrast, PTFE patch suture augmentation demonstrated statistically higher initial failure loads than did the control and was of specific benefit for shoulders with weak bone stock.

Adult↗

Trends in the development of bioresorbable polymers for medical applications.

The gradual shift from biostable prostheses to degradable, temporary implants represents one of the most significant trends in biomaterials research. In view of this trend, medical applications of degradable implant materials were reviewed with special emphasis on orthopedic polymeric implants. Among the polymeric implant materials derived from natural sources, collagen, various polysaccharides such as cellulose, and microbial polyesters have been intensively investigated. Among the synthetic, degradable polymers, aliphatic polyesters such as poly(glycolic acid), poly(lactic acid), poly(caprolactone) and polydioxanone, are most commonly investigated. Only recently, several new classes of polymers such as poly(ortho esters), polyanhydrides, and degradable polycarbonates have been introduced as potential implant materials. A particularly versatile group of new biomaterials with promising engineering properties are the "pseudo"-poly(amino acids), amino acid derived polymers in which conventional peptide bonds have been replaced by various chemical linkages.

Absorption↗

Osteolytic changes after polyglycolide pin fixation in chevron osteotomy.

Absorbable polyglycolide pins were used for fixation of 94 chevron osteotomies in 70 patients at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, between 1986 and 1992. Postoperative osteolytic changes around the degrading pin occurred in 21 of 94 (22%) metatarsal heads. In 17 of 21 metatarsal heads, polydioxanone-coated polyglycolide pins were used. This type of pin has not been used since 1988. At follow-up, 16 of 21 osteolytic changes resolved completely and four partially resolved. In the remaining one, the osteolytic area remained visible after 6 years. Cystic changes in the metatarsal head, not attributable to the location of the absorbable implants, occurred in seven (7.4%) metatarsal heads and avascular necrosis of the entire metatarsal head in one (1.1%). Foreign body reaction occurred in six (6.3%) metatarsal heads and wound infection in three (3.2%) metatarsal heads. No association was observed between osteolytic changes and foreign body reaction or infection. Osteolysis in patients receiving polyglycolide implants only require observation, because associated symptoms with the radiographic findings are transient.

Adolescent↗

The effect of suture materials and techniques on the outcome of repair of the rotator cuff: a prospective, randomised study.

In a prospective, randomised study on the repair of tears of the rotator cuff we compared the clinical results of two suture techniques for which different suture materials were used. We prospectively randomised 100 patients with tears of the rotator cuff into two groups. Group 1 had transosseous repair with No. 3 Ethibond using modified Mason-Allen sutures and group 2 had transosseous repair with 1.0 mm polydioxanone cord using modified Kessler sutures. After 24 to 30 months the patients were evaluated clinically using the Constant score and by ultrasonography. Of the 100 patients, 92 completed the study. No significant statistical difference was seen between the two groups: Constant score, 91% vs 92%; rate of further tear, 18% vs 22%; and revision, 4% vs 4%. In cases of further tear the outcome in group 2 did not differ from that for the intact repairs (91% vs 91%), but in group 1 it was significantly worse (94% vs 77%, p = 0.005). Overall, seven patients had complications which required revision surgery, in four for pain (two in each group) and in three for infection (two in group 1 and one in group 2).

Adult↗

Biliopancreatic diversion with transitory gastric restriction and duodenal bulb preservation: 88 patients since 1992.

BACKGROUND: Over 10 years, 88 patients underwent biliopancreatic diversion with transitory gastric restriction (BPD-TGR) as a first choice operation or after gastric restrictive procedures. METHODS: From 1992 to 1999, BPD-TGR was performed on 71 patients as a first choice operation (Group 1 - BMI 41.9 +/- 6.5). The TGR was achieved by a polydioxanone (PDS) band. The duodenal bulb was maintained to 5 cm distal to the pylorus, constructing an end-to-side antecolic isoperistaltic duodeno-ileal anastomosis. Since 1993, a further 17 patients underwent BPD-TGR as a correction for restrictive procedures (Group 2 - BMI 37.4, range 27.2-61.0). RESULTS: Results in weight loss in Group 1 were similar to those in our previous classical BPD. Percent excess weight loss (%EWL) was 68.0 +/- 18.4, 75.9 +/- 12.3, and 75.4 +/- 12.0 at 1,5 and 10 years respectively. No patient had severe dysproteinemia (only 3% of patients had hypoalbuminemia of 3.0-3.4 g/dl). There was no case of diarrhea or halitosis. Anastomotic ulcers occurred in 2% of the patients. In Group 2, the patients had weight loss already present from the first operation, which continued after BPD-TGR with great variability from patient to patient. %EWL was 35.1 (range 0 to 72.5) and 35.2 (range 18.4 to 43.2) at 1 and 5 years. CONCLUSIONS: BPD-TGR appears to be an effective operation with few complications and also a satisfactory correction for failed gastric restrictive procedures, or even a sequential operation in the super-obese.

Adult↗

Biliopancreatic diversion with transitory gastroplasty preserving duodenal bulb: 3 years experience.

BACKGROUND: The authors have performed 521 bariatric surgery operations (319 restrictive procedures and 202 malabsorptive procedures). METHODS: During the last few years we have introduced an evolution of biliopancreatic diversion (BPD): BPD with transitory gastroplasty, preserving the duodenal bulb (53 cases). From a technical point of view, the operation consists of a BPD, coupled with a gastroplasty which is transitory due to the use of a polydioxanone (PDS) band. In the last few cases, instead of a VBG (with PDS band) in order to make the operation completely reversible without any suture on the stomach, we made a gastric pouch by banding with PDS calibrated with the same tube as for the Lap-band (20 cc). We maintained completely the duodenal bulb (5 cm from the pylorus), making an end-to-side duodeno-ileal isoperistaltic anastomosis. RESULTS: With this anastomosis, only 2% of patients developed an anastomotic ulcer. With this new procedure, results have been good in terms of weight loss (similar to that of BPD-AHS) and in nutritional complications. No patient has had hypoalbuminemia, diarrhea or halitosis. CONCLUSION: BPD with temporary gastric restriction has provided satisfactory results.

Adult↗

Guided tissue regeneration with bioabsorbable barriers. II. Long-term results in infrabony defects.

BACKGROUND: The aim of this 5-year randomized controlled clinical trial was to evaluate the long-term results after guided tissue regeneration (GTR) therapy of infrabony defects using two bioabsorbable barriers. METHODS: Fifteen pairs of contralateral infrabony defects in 15 patients with moderate to severe periodontitis were treated. Each patient received one polydioxanon (test: T) and one polylactide acetyltributyl citrate (control: C) barrier by random assignment. At baseline, 12, and 60 +/- 3 months after surgery clinical parameters and standardized radiographs were obtained. Vertical bone levels (PBL-V) were measured during surgery and 60 +/- 3 months later by transgingival bone sounding. RESULTS: Thirteen patients were available for the 60-month examinations. Twelve and 60 +/- 3 months after GTR, statistically significant (P< or =0.001) vertical attachment (CAL-V) gain was found in both groups (T12: 3.5 +/- 1.5 mm; T60: 2.2 +/- 1.8 mm; C12: 4.0 +/- 0.9 mm; C60: 2.4 +/- 1.0 mm). However, from 12 to 60 months after therapy both groups experienced significant CAL-V loss (P<0.05): two defects in the test group and three in the control group had CAL-V loss >2 mm compared to the 12-month reexamination. Twelve and 60 +/- 3 months after surgery, statistically significant (P<0.05) radiographic bony fill was found in both groups (T12: 1.2 +/- 1.3 mm; T60: 1.5 +/- 2.2 mm; C12: 0.9 +/- 1.4 mm; C60: 1.0 +/- 1.6 mm). Further, 60 months after surgery significant (P<0.05) PBL-V gain was found in both groups (test: 1.8 +/- 2.3 mm; control: 2.2 +/- 1.8 mm). The study failed to show statistically significant differences between test and control regarding CAL-V and PBL-V gain 60 months after surgery. CONCLUSION: CAL-V gain achieved after GTR therapy in infrabony defects using both bioabsorbable barriers was stable after 5 years in 21 of 26 defects (81%).

Adult↗

Foreign body attachment to polypropylene suture material extruded into the small intestinal lumen after enteric closure in three dogs.

Three dogs in which polypropylene suture material was used to close an enteric surgery site in a continuous pattern were evaluated at a later date because of recurrence of signs of intestinal disease. Surgery in each dog revealed that the suture material had been extruded into the lumen of the intestine and acted as a site for attachment of a foreign body. The nonabsorbable nature of polypropylene and its use in a continuous pattern are possible explanations for this complication. Polydioxanone or poliglecaprone 25 may be suitable alternatives to polypropylene for use in a continuous pattern for closure of small intestinal surgery sites.

Animals↗

A simple continuous pattern using absorbable suture for perineal urethrostomy in the cat: 18 cases (2000-2002).

Closure with a simple continuous pattern using absorbable suture was evaluated in 18 cats that underwent perineal urethrostomy from 2000 to 2002. The perineal urethrostomy was performed in a similar manner in all the cats, and either 4-0 or 5-0 polydioxanone was used for closure. Cats were evaluated 2 weeks postoperatively, and long-term follow-up information was reviewed. In all cats, the perineal urethrostomy site was healed within 2 weeks. None of the cats developed a stricture postoperatively. Complications were not significantly different (P>0.50) from those found in a comparison group of 21 cats operated between 1997 and 2002, in which perineal urethrostomies were performed using nonabsorbable sutures that were removed postoperatively.

Animals↗

Comparison of seven different suture materials in the feline oral cavity.

Seven different suture materials were implanted into the oral tissues of 12 cats. The sutures and surrounding tissues were retrieved en bloc from each of two cats on days one, three, seven, 14, 21, and 28 postimplantation. Tissue reaction and suture duration were evaluated by gross visual observation and histological examination. Chromic gut disappeared between days three and seven; polyglactin 910 disappeared between days 14 and 21; and polyglycolic acid disappeared as early as seven to 14 days. Polydioxanone still was intact at day 28 and is recommended as an absorbable material for procedures in which longer healing time is anticipated. All the nonabsorbable suture materials (i.e., polypropylene, stainless steel, and nylon) were intact at day 28 postimplantation. Visual inspection showed polypropylene to have the least tissue reaction.

Animals↗