Surgical technology international最新文献

Introduction: The purpose of this article is to describe a standardized approach for creating a physician-modified endovascular graft (PMEG) based on the Zenith Flex® (Cook Medical Inc., Bloomington, Indiana) platform.

Technique: A sterile template is constructed based on computed tomography angiography (CTA) measurements. Once the Zenith Flex® bifurcated endograft is desheathed, the template is placed over the device and adjusted so that the planned fenestrations do not overlap with the struts. The fenestration locations are marked on the fabric of the endograft and created using high-temperature cautery. The distal part of a snare is obtained, braided around a modified angiometer with a diameter matching the fenestration, and secured around the corresponding fenestration with locking sutures. Diameter-reducing ties are added by first securing a suture loop at the 12 o'clock position of each Z-stent, then the trigger wire is repositioned to the outside of the endograft at the 6 o'clock position and threaded through each of the loops to constrain the Z-stents. The endograft is reloaded through the peel-away sheath and is ready for the procedure.

Conclusion: A PMEG with diameter-reducing ties and reinforced fenestrations can be constructed in a standardized fashion using the Zenith Flex® platform, providing an endovascular treatment option for complex abdominal aortic aneurysms when custom-made endografts are unavailable.

Clinical impact: Fenestrated endovascular aortic repair is an important treatment option for complex abdominal aortic aneurysms. However, custom-made fenestrated devices may not be available in all regions or medical centres, and their use is limited in urgent situations. Familiarity with constructing a physician-modified endovascular graft can provide patients with an endovascular treatment option in such situations. This step-by-step guide to constructing a physician-modified endovascular device based on the Zenith Flex® platform can help surgeons create a bespoke fenestrated device with diameter-reducing ties and reinforced fenestrations in a standardized fashion within a matter of hours.

Introduction: A surgeon performing kinematically aligned total knee arthroplasty (KA TKA) through a mid-vastus approach can use an insert goniometer to select the optimal insert thickness. The insert goniometer provides the value of soft-tissue-driven tibial internal rotation during passive knee flexion. This study tested whether the insert goniometer can identify one insert thickness that maximizes tibial rotation while restoring full knee extension during KA TKA performed through a medial parapatellar approach.

Materials and methods: One surgeon trialed goniometer inserts from a 10 to 14mm thickness with a medial ball-in-socket and flat lateral articular conformity in 33 patients treated with unrestricted caliper-verified KA, PCL retention, and a medial parapatellar approach. The medial insert had markings that measured tibial orientation relative to a sagittal line on the femoral trial component at full extension and 90° flexion (+ external/ - internal). The difference of tibial external orientation in extension and tibial internal orientation at 90° flexion computed tibial internal rotation.

Results: Of the 33 TKAs, a 10mm (N =13) or 14mm thick (N =2) insert maximized tibial internal rotation. In these TKAs, a 1mm thinner or thicker liner was not trialed, respectively. The remaining liner thicknesses maximizing tibial rotation were 11mm in 12 TKAs, 12mm in four TKAs, and 13mm in two TKAs. Mean ± SD maximal tibial rotation was 17 ± 4.1°, which was 4° more than with a 1mm thinner (13 ± 5°) and 1mm thicker (13 ± 5.3°) insert (p<0.001).

Conclusions: Surgeons performing KA TKA through a medial parapatellar approach can utilize the insert goniometer to select the insert thickness that maximizes tibial rotation. Maximizing tibial rotation with a medial ball-in-socket and lateral flat insert conformity restores physiologic knee kinematics and dynamically stabilizes the patella.

Introduction: Chronic wounds, burns, and traumatic injuries present significant clinical challenges due to infection risks, delayed healing, and complications such as scarring. Advanced wound care has evolved with the development of skin substitutes, categorized into biologic and synthetic matrices. Synthetic skin substitutes have gained popularity due to their reduced risk of disease transmission, cost-effectiveness, and ability to enhance wound healing through structural support and bacterial biocidal properties.

Materials and methods: This review uses the Centers for Medicare and Medicaid to identify unique synthetic skin substitutes. Each company was contacted to obtain details about their respective products, including their composition, mechanisms of action, clinical applications, and advantages. Studies, case reports, and clinical trials from the PubMed database, Google Scholar, and ClinicalTrials.gov were also assessed to compare the effectiveness of these products in managing acute, chronic, and complex wounds.

Results: The review found that synthetic skin substitutes offer several key advantages in managing chronic and complex wounds. These substitutes enhance wound healing by promoting cell migration, granulation tissue formation, and angiogenesis. They are also associated with improved cosmetic outcomes, reduced infection risks, and quicker wound closure. Many of the products reviewed demonstrated significant improvements in healing rates, with some showing faster recovery than traditional treatments. Additionally, the synthetic materials reduced the need for frequent dressing changes and minimized discomfort for patients. Overall, the results indicate that synthetic skin substitutes effectively improve wound care outcomes across various wound types.

Conclusion: While synthetic skin substitutes offer promising outcomes in wound management, limitations such as high initial costs and the need for further research persist. Nonetheless, their ability to reduce infection risks, accelerate healing, and improve patient comfort makes them a valuable alternative to traditional biologic substitutes. Future studies should focus on long-term cost-effectiveness and broader clinical applications to validate their widespread use.

Introduction: The results of cementless robotic-assisted total knee arthroplasty (RA-TKA) have not been evaluated in obese patient populations. The purpose of this study was to evaluate the rates of aseptic loosening, patient-reported outcomes, and surgical complications of cementless RA-TKA cases in obese and nonobese patient cohorts.

Materials and methods: A retrospective review between 2018 to 2021 of a single-surgeon series was conducted, producing 1,546 patients. Patients were categorized as either obese (body mass index [BMI] <35) or nonobese (BMI <35), generating 472 and 1,092 patients, respectively. The average BMI was 40.5 (range, 35.0 to 64.1) in the obese group and 28.6 (range, 16.5 to 34.9) in the nonobese group. The primary outcome was the rate of aseptic loosening. Secondary outcomes included patient-reported outcomes, comprising Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement (KOOS JR) scores, and the reduced Western Ontario and McMaster Universities Arthritis Index (r-WOMAC) scores. Charts were reviewed to establish rates of postoperative surgical complications. Significance tests were conducted using either t-tests or Chi-squared independence tests, and a p-value of <0.05 was considered significant.

Results: There were no cases of aseptic loosening in the obese or nonobese cohorts, making survivorship 100% for both. While preoperative KOOS JR and r-WOMAC scores were significantly worse in the obese group, they were not statistically significant at either six-week or 12-month timepoints. The obese cohort had statistically greater improvements in r-WOMAC total scores at six weeks and 12 months; they also had statistically significant superior improvement in KOOS JR at 12 months. There were no statistically significant differences in postoperative surgical-related complications.

Conclusion: We demonstrated that rates of aseptic loosening and patient-reported outcomes in obese patients undergoing RA-TKA are excellent, and patient-reported outcomes demonstrated superior improvement in the obese cohort compared to those in the non-obese cohort.

There were 63 outpatient medial unicompartmental knee arthroplasties (UKAs) performed by Mako robotic assistance by six surgeons. There were 40 men and 23 women who had a mean age of 65.1 years (range, 38 to 80). Their mean body mass index (BMI) was 29.6 (range 21.8 to 39.2), and 28 patients had a BMI over 35. Overall, patient perceptions of the procedure were excellent (mean 9.2 rating of 10), which was not different by sex or body mass index. There were no 30-day complications or readmissions. At one year, there was one case revised for maltracking, resulting in a revision rate of 1.6% (1 out of 63 patients) with no cases of aseptic loosening. There were two other patients that had minor procedures (nerve ablation and removal of a loose body). The results of this prospective study confirm that outpatient robotic-arm assisted medial UKA is safe and feasible with a positive patient perspective of the procedure.

Chronic wounds are notoriously challenging to heal as they are often halted in their normal healing process. The concept of TIME (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge advancement) has been widely utilized in clinical practice to prepare wound beds and promote healing, particularly in longstanding wounds. Traditional methods of wound bed preparation are often inadequate in healing chronic wounds or they may not be tolerated by patients. A variety of interventions have been developed in recent decades to address these components and improve chronic wound outcomes. Evolutions in tissue preparation include emerging enzymatic debridement agents and ultrasound-assisted debridement. Wound infection can be managed through a variety of new methods including advanced wound dressings, surfactants, and fluorescence imaging. Portable negative pressure wound therapy devices provide a new, convenient method for exudate management. Finally, epithelial advancement can be enhanced with technologies such as cellular, acellular, and matrix-like products (CAMPs), topical medications, and electrical stimulation.

Pelvic Venous Disorder (PEVD) and May-Thurner syndrome (MTS) represent relatively understudied vascular issues that can significantly impact patients' quality of life. This study aims to evaluate the efficacy of surgical treatment for PEVD and MTS, conduct a comparative analysis of outcomes, and determine the practical significance of different therapeutic approaches. The study was conducted from 2019 to 2022 in Moscow, Russia, encompassing two outpatient clinics. A total of 132 patients diagnosed with pelvic venous disorder and/or May-Thurner syndrome (MTS) participated in the research. Diagnostic confirmation relied on ultrasound, transrectal ultrasound, and magnetic resonance imaging. Surgical treatment methods included angioplasty and stenting of the iliac veins. Evaluation of outcomes was based on a comparison of symptoms and additional investigations before and after treatment. It was found that 36% of patients had a history of previous varicocelectomies, with 21% of them having undergone prior surgical interventions. Comorbidities included chronic prostatitis, sexual dysfunction, haemorrhoids, and the presence of varicose veins in the legs, with these pathologies observed in more than 50% of cases. Following the surgical intervention (placement of stents on the left common iliac vein, LCI), a significant improvement in condition was observed in 91% of cases. The obtained results confirm the high efficacy of surgical intervention in the case of PEVD and MTS. The research findings can assist physicians in making more informed decisions when choosing treatment methods for patients with these conditions.

Thermal or burn injuries cause coagulative necrosis of the epidermis and underlying tissues and the resultant wounds can be long lasting and highly painful. Depending on the depth of a burn, management ranges from local wound care to surgical intervention. When presented with deep-partial thickness and full-thickness burns, autologous skin grafting has been the mainstay of management to prevent scarring and promote healing. However, since the early 2000s, there has been increasing interest in reducing, if not eliminating, the need for autologous grafting considering the morbidity and pain associated with donor site harvesting, lack of appropriate donor sites in the case of larger burns, and to improve overall cosmetic outcomes. In this article, we discuss the available products on the market for the treatment of thermal burn injuries, explore the data advocating for their use and discuss their limitations, and highlight the unique efficacy of intact fish skin grafts, in particular, in this specific patient population.

Thermal or burn injuries cause coagulative necrosis of the epidermis and underlying tissues and the resultant wounds can be long lasting and highly painful. Depending on the depth of a burn, management ranges from local wound care to surgical intervention. When presented with deep-partial thickness and full-thickness burns, autologous skin grafting has been the mainstay of management to prevent scarring and promote healing. However, since the early 2000s, there has been increasing interest in reducing, if not eliminating, the need for autologous grafting considering the morbidity and pain associated with donor site harvesting, lack of appropriate donor sites in the case of larger burns, and to improve overall cosmetic outcomes. In this article, we discuss the available products on the market for the treatment of thermal burn injuries, explore the data advocating for their use and discuss their limitations, and highlight the unique efficacy of intact fish skin grafts, in particular, in this specific patient population.