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[Chemical synthesis of biodegradable poly-para-dioxanone and its application for mandibular fracture fixation].
OBJECTIVE: To observe mandibular fracture healing after synthesized bioabsorable poly-para-dioxanone (PDS) ligature fixation. METHODS: Para-dioxanone monomer was prepared by chemical reactions of metallic sodium, ethylene glycol and other raw materials. PDS was synthesized by polymerizing the purified para-dioxanone in the presence of catalyst under the conditions of negative pressure and certain temperature. PDS ligature was obtained by processing the polymer into small granules, drying and melt-extruding through a spinnerette. Eighteen adult male New Zealand rabbits were assigned randomly into two groups. After mandibular fracture models were created, reductions of the artificial fractures were accomplished by means of transosseous PDS ligatures on each of 12 rabbits in experimental group. While the other six rabbits without any internal fixation were set as control. Schedules for killing were arranged to give postoperative samples at two-week interval till 12th week. RESULTS: Radiographical and histological examinations demonstrated that all fractures fixed with PDS ligatures healed without any complication. Periosteal and cartilaginous osteogenesis was observed in newly formed external callus. In contrast, bone fragment migration and the consequent nonunion occurred in the control group. PDS ligature degraded and absorbed without interference with osseous union and healing. The tensile strength reduction of PDS ligature was prior to its absorption in vivo. CONCLUSION: The synthesized PDS is a colorless, flexible, themoplastic and monofilament fiber, which can be sterilized by ethylene oxide embalmment without serious loss of tensile strength. It seems that the application of this macromolecular material in internal fixation is of great worth for further study.
[Delayed positioning of multifilament tape (IVS transobturator tape) in treatment of stress urinary incontinence caused by the radiotherapy].
Radiotherapy is used to treat advanced stages of cervical cancer. Despite optimization of the doses delivered during radiotherapy chronic urinary tract complications still occur in 1-5% of patients. We report a case of 60 years old woman, treated 10 years ago for stage III cervical carcinoma. She received both intracavitary brachytherapy and external teletherapy. Since irradiation patient suffered from the stress urinary incontinence (SUI). She was diagnosed in our department and underwent successful anti-incontinence surgery. Because of oncological history and urodynamic parameters (markedly lowered closing urethral pressure) she was assigned to intravaginal slingplasty transobturator (IVS-OT) procedure with delayed positioning of the tape. There were no intra- or postoperative complication. The check-up done four months following surgery revealed that patient have full control of micturition and markedly improved quality of life.
[Reabsorbable banding. Our initial experience].
Since May 1989 we have been using a reabsorbable 3 mm, polidioxanona band for pulmonary banding instead of the dacron one. This procedure was performed in 5 patients with ages between 33 to 230 days. The diagnoses were atrioventricular canal in one case and ventricular septal defect in the other 4 cases. One of them also had vascular ring with right aortic arch, left patent ductus arterious and aberrant subclavian artery. All the patients were in a poor condition. Subsequent reoperations performed in short, medium, and long term were uncomplicated, and the technique had the added benefit of avoiding the need for pulmonary reconstruction. A close ECO Doppler follow-up is necessary to determine the best moment for definitive correction. We think that this new technique makes the banding a reliable and complications free procedure and its place should be reevaluated in the light of the current tendency for early complete correction.
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.
Comparison between absorbable and nonabsorbable sutures in arterial anastomoses in growing dogs.
Five dogs, 10 weeks old, underwent operation using ketamin-HCl anesthesia and end-to-end anastomoses of the femoral and brachial arteries were made using polyfilament nonabsorbable material (Ethibond), monofilament nonabsorbable material (Prolene), polyfilament absorbable material (Vicryl) and monofilament absorbable material (PDS). The arterial diameter using a micrometer and blood flow using an electromagnetic flow meter were determined. After six months another operation was performed and diameter and blood flow were measured again. No statistically significant differences were found between the different materials used with respect to growth related increases either in arterial diameter or blood flow.
Fixation of the Austin osteotomy with bioresorbable pins.
Clinical trials were conducted at the Foot Clinics of New York, testing the use of the Johnson & Johnson Orthosorb absorbable pins as an integral absorbable form of fixation of the Austin osteotomy. Two Orthosorb pins were inserted across the osteotomy from dorsal to plantar. Patients were placed in a plaster splint and allowed to walk with weightbearing as tolerated within 2 weeks of the procedure. A protocol was designed to include a 6-month follow-up with regularly scheduled postoperative examinations. These examinations included a review of pain, walking ability, edema, and measurements of dorsiflexion and plantarflexion. No complications have occurred in this patient population. This study has shown that for a selected group of surgical candidates, Orthosorb bioresorbable pins are an effective form of fixation for the Austin osteotomy.
[Aortic isthmus stenosis: a comparison of resorbable and non-resorb able sutures].
Absorbing vessel suture material presents the particular advantage of unlimited growth potential of young vessels. This is due to low tissue irritation and only a minimum of foreign-body reaction of the tissue. Retrospectively, we compared 9 patients (5 +/- 3 years of age), who underwent resection of the coarctation and end-to-end reanastomosis, with absorbing simple continuous suture material versus 8 patients (7 +/- 5 years of age; NS) with non-absorbing suture material using a prolong-thread suture technique, who were operated between 1980 and 1986. The growth increase before to 4 years after operation (24 +/- 10% in the "absorbing suture group-A" and 36 +/- 27% in the "non-absorbing suture group-B"; NS) just as the pressure gradient (55 +/- 11 mm Hg in group A, 58 +/- 16 mm Hg in group B (NS) before and 6 +/- 8 mm Hg in group A, 5 +/- 9 mm Hg in group B (NS) 4 years after operation) shows no significant difference. Therefore one may say that absorbing material in simple continuous suture technique presents a good alternative to the non-absorbing material in the prolonged-thread suture technique for correction of aortic isthmus stenosis, whereby analogous growth can be expected.
[Primary correction of orbital fractures using PDS-foil].
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[Indication for, technique and results of reconstruction of traumatic defects of the bony orbital floor].
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[Long-term results following orbital comminuted fractures with special reference of orbital floor reconstruction using an absorbable PDS-plate].
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[Animal experiments for the determination of in-vivo absorption of PDS osteosynthesis material].
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[Present-day suture materials in operative gynecology].
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[Ligament reinforcement with resorbable PDS cord and early functional after-care. Results of follow-up of surgically managed cruciate ligament injuries].
After operating on the injured cruciate ligaments, immediate mobilization and protection of the healing ligament are indispensible. However, no approach has yet been shown to safely provide both. Therefore, in 1984 we introduced a new technique: the repaired or reconstructed cruciate ligaments are augmented with a biodegradable material - a doubled-over PDS cord, 1.5 mm in diameter. It allows for immediate and safe mobilization. Because of its appropriate elasticity it does not cause "stress shielding." Postoperatively, the patients are mobilized on a motorized frame for 2 weeks. Subsequently, we have used a limited mobilization cast (LMC). Forty-nine out of 63 patients (78%) have now been reexamined for this follow-up study, using the score from the Hospital for Special Surgery and stress X-rays in the Lachmann, position (30 degrees flexion). The results compare favorably with a prior follow-up study of patients from our hospital without PDS augmentation and without early mobilization. The knees in the present study are more stable and have a better range of motion, particularly when the LMC was used.
[Surgical absorbable suture materials].
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[Monofilament absorbable sutures].
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[Follow-up results of ligament replacement by PDS in chronic lateral ligament instability of the upper ankle joint].
From September 1988 till February 1989 we have operated on 14 PDS-ligament replacements of the ankle in patients with chronic lateral instability. Only one patient had an excellent clinical result with a stable ankle. Ten of twelve patients had poor results at follow-up. 2 patients had been reoperated on. We did not find biological substitute along the PDS guide line. This suggested the opinion, the PDS-ligament replacement of the ankle can't realize the expectations.
Fibrous changes and presence of calcium in the vessel walls six months after end-to-end arterial anastomoses in growing dogs.
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