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At least 145 records · Page 8Linked to original sources
PubMed1985

High domed tibial osteotomy in the treatment of angular deviations of the knee. A new system of surgical instrumentation.

The case reports are presented of 26 knees with angular deviations in the frontal plane (19 varus and 7 valgus), treated by high domed tibial osteotomy with external skeletal fixation. Clinical and radiographic controls were carried out at a minimum of 6 months and a maximum of 3 years later. The new surgical instrumentation devised by the authors is described; this allows precise measurement of the angle of correction at operation.

Adolescent↗
PubMed1994

Hematologic and circulatory changes associated with total knee arthroplasty surgical instrumentation.

This study evaluated the effects of intramedullary instrumentation when used on the femur and tibia. Twenty-six patients (52 knees) undergoing bilateral index cemented total knee arthroplasty were analyzed. Bilateral knee arthroplasties were chosen because the increased surgery would theoretically maximize any perioperative hemodynamic or hematologic changes. Patients were randomized into one of two groups depending on the exact form of surgical instrumentation used. Group I (intramedullary) knees were implanted with standard intramedullary fluted instruments. No special measures to vent the entrance holes were made. Group II (extramedullary) knees were implanted with an extramedullary tibial guide, in conjunction with an intramedullary femoral guide placed through a vented femoral hole. All patients manifested significant changes in their hematologic and hemodynamic values after arthroplasty. Leukocytes increased 85% on average, whereas fibrinogen (106%) and erythrocyte sedimentation rates (145%) also showed significant increases. Conversely, patients exhibited a relative thrombocytopenia (63%) nadiring on the second postoperative day. However, there was no significant differences seen between the two instrumentation groups. Hemodynamically, all patients exhibited rises in cardiac index (52%) and pulmonary artery pressures (64%). Analysis of the hemodynamic results in this study does demonstrate subtle evidence of increased pulmonary vascular resistance in the intramedullary group. Specifically, the intramedullary group had lower cardiac indexes, in association with higher pulmonary pressures. This increase in pulmonary vascular resistance with the use of intramedullary instrumentation may represent subtle evidence of increased lung injury in this group. Results point to the continued use of fluted intramedullary rods and vented entrance holes as a reasonable surgical technique in patients undergoing knee arthroplasty.

Aged↗
PubMed1998

Rapid Fire Hair Implanter Carousel. A new surgical instrument for the automation of hair transplantation.

BACKGROUND: As hair transplantation evolved into a procedure in which large numbers of very small grafts are moved in a single session, new problems have emerged. These include greater staffing requirements, longer operating time, additional technical difficulties, and increasing problems with quality control. OBJECTIVE: To introduce a new surgical instrument, the Rapid Fire Hair Implanter Carousel (Carousel), which can automate the most labor-intensive parts of the hair transplantation process, site creation and implant placement, by combining them into a single step and delivering them in rapid sequence. This instrumentation should help to minimize some of the human factors contributing to graft injury and to simplify and increase the speed of the hair transplant procedure. METHODS: In a patient with a Norwood IIIA balding pattern, 400 follicular implants were placed into a specific section of the bald scalp. The remainder of the bald scalp was transplanted with 800 follicular implants placed in the traditional way. The two areas were monitored and compared for intraoperative bleeding, ease of placing, total placing time, postoperative healing, and hair growth. Photographic documentation was obtained after surgery and at each postoperative visit. RESULTS: The Carousel visually produced less bleeding when compared with the manual approach. The Carousel was easier to use than the manual technique, since it eliminated graft insertion as a separate step. This was evidenced by the significantly shorter time required to insert the implants (40 grafts/minute with the Carousel vs 6.6 grafts/minute manually) and the decreased need for secondary manipulation once the grafts were inserted. Postoperative healing of the two groups were the same with regard to the duration of crusting and erythema. The rate of hair growth and the total amount of hair observed at 4 months were the same when identical size areas in test and control sides were compared. CONCLUSION: In this single patient pilot study, the Carousel greatly facilitated the placement of grafts by decreasing bleeding and obviating the extra step needed for the insertion of the implants. As a result, the total operative time decreased, shortening the time the grafts were outside the body, and decreasing the risk of desiccation and warming. By minimizing the human factor in this labor-intensive part of the procedure, the quality of the hair transplant should increase. It is anticipated that these benefits will result in increased hair yield. Further studies are needed, in a larger patient group, so that these benefits can be demonstrated.

Adult↗
PubMed1986

The computer as a stereotactic surgical instrument.

We have developed methodology and stereotactic software for an operating room computer and imaging system. Patients undergo preoperative CT, MR and DSA imaging with their heads fixed in a stereotactic headholder. Localization systems attach to the headholder during the studies to create reference marks for computer transformation of points and volumes into three-dimensional stereotactic space. At the operating room computer console, the surgeon selects target points, avascular trajectories and tumour boundaries for volume reconstruction. Surgical approaches are simulated and target coordinates calculated. During surgery, the computer interactively monitors the position of stereotactically directed surgical instruments in relationship to the resident database along any viewing angle and conveniently superimposes the multiple data sources. We have found this system useful to provide rapid data acquisition and retrieval, accurate target point calculations, lesion volume reconstructions, and a convenient ability to reformat data from multiple sources in a manner useful to the surgeon and beneficial to the patient.

Angiography↗