Surgical technology international最新文献

{"title":"Modified Lightbulb Non-Vascularized Bone Grafting Technique for Osteonecrosis of the Femoral Head.","authors":"Tyler Edmond,&nbsp;Daniel Hameed,&nbsp;Devin Olsen,&nbsp;Jeremy A Dubin,&nbsp;Erica Grynovicki,&nbsp;Michael A Mont","doi":"10.52198/23.STI.42.OS1677","DOIUrl":"https://doi.org/10.52198/23.STI.42.OS1677","url":null,"abstract":"<p><p>Multiple techniques for non-vascularized bone grafting for the treatment of femoral head osteonecrosis have been proposed with varying degrees of success. The success of these procedures may be improved with the use of ancillary growth and differentiation factors. The trephine (Phemister) technique allows for limited decompression of the femoral head through two percutaneous tunnels, while the direct approach through the femoral head (\"trapdoor\" technique) may result in damage to the articular cartilage. Herein we provide our modified \"lightbulb\" technique to decompress the femoral head through a window at the femoral head-neck junction that provides excellent, direct access to the osteonecrotic lesion. Adjuvant, non-vascularized bone graft, comprised of bone marrow aspiration concentrate (BMAC) and open matrix bone graft (MagnetOs Flex Matrix, Kuros Bioscience, Bilthoven, Netherlands) is a unique fibrillar and flexible structure that provides bone induction and further structural support to create a favorable environment for bone formation and healing. This is a straight-forward, hip-preserving, surgical technique that may be used for symptomatic management to delay, or potentially obviate, the need for total hip arthroplasty in patients who have medium- to large-sized or early-collapse lesions of the femoral head.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41110514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acellular Fish Skin for Tissue Replacement.","authors":"Callie Horn,&nbsp;Allegra Fierro,&nbsp;John C Lantis","doi":"10.52198/23.STI.42.WH1710","DOIUrl":"https://doi.org/10.52198/23.STI.42.WH1710","url":null,"abstract":"<p><p>In modern practice, xenografts play a crucial role in wound management due to their regenerative properties. Of the various xenografts currently available on the market, acellular fish skin (AFS) grafts have emerged as a more effective alternative to existing xenografts and other standard of care (SOC) treatments for wound healing. Since AFS grafts require minimal processing, they maintain their structural integrity and natural properties, including an abundance of Omega-3 fatty acids, which is a distinctive, pro-regenerative feature. AFS grafts are also unique in that they are not derived from mammalian tissue, so there is no risk of viral transmission and no cultural or religious barriers to use. AFS grafts have been shown to be more cost-effective in the treatment of diabetic foot ulcers (DFUs) and result in a higher percentage of healed wounds, fewer amputations, and better patient quality of life. Several studies and case reports have highlighted the versatility of AFS in not only acute and chronic wound healing, but also for burn wound skin regeneration. Additionally, AFS may have promise as an implantable biologic matrix for suture line reinforcement in hernia repairs or breast and dura reconstruction.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acellular Fish Skin Graft Use in Open Abdomen Management.","authors":"Rifat Latifi,&nbsp;Abbas Smiley","doi":"10.52198/23.STI.42.GS1705","DOIUrl":"https://doi.org/10.52198/23.STI.42.GS1705","url":null,"abstract":"<p><strong>Introduction: </strong>Open abdomen (OA) management post damage control laparotomy (DCL) is common in complex abdominal trauma and intra-abdominal catastrophe (IAC). Use of polyglactin 910 mesh (VICRYL™, Johnson & Johnson, New Brunswick, New Jersey) to cover the intra-abdominal contents and wound vacuum-assisted closure (VAC) is current practice in the management of temporary abdominal closure (TAC). This may have complications and requires two to three weeks for granulations to be ready for skin grafting. Acellular fish skin graft (AFSG; Kerecis™, Reykjavik, Iceland), use in wound care management has proven beneficial in the management of both chronic and acute wounds, such as burns, by increasing wound granulation. However, to our knowledge, its utility in OA management has not been reported.</p><p><strong>Objective: </strong>The objective of this report is to introduce a novel use of AFSG (Kerecis™) in open abdomen to decrease the time of TACs by accelerating formation of granulation tissue and placement of skin grafts in patients with post damage control laparotomy (DCL) for trauma and IAC when committed to open abdomen management is presented.</p><p><strong>Materials and methods: </strong>Illustration of application of AFSG (Kerecis™) in two patients who underwent DCL for IAC and OA management is presented.</p><p><strong>Results: </strong>Two patients with intra-abdominal catastrophe post-DCL and fistulae were enrolled; one with postoperative enteric fistula and the other with post-anastomotic ileo-colonic fistula breakdown and major intra-abdominal sepsis resulting in multiple organ system failure (MOSF). In both cases, a hostile abdomen was present. The application of AFSG accelerated the placement of skin grafts in both patients and decreased the use of wound VAC and hospital length of stay.</p><p><strong>Conclusion: </strong>This report illustrates the use of AFSG (Kerecis™) to accelerate placement of skin grafts in patients post-DCL and OA management. AFSG (Kerecis™) could be considered as part of the OA management strategy.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Three-Dimensional Custom Printing in Revision Total Hip Arthroplasty.","authors":"Katy Kim,&nbsp;Nemandra A Sandiford","doi":"10.52198/23.STI.42.OS1698","DOIUrl":"https://doi.org/10.52198/23.STI.42.OS1698","url":null,"abstract":"<p><p>Acetabular revision accounts for approximately 18% of all total hip arthroplasty (THA) procedures. This was the third most common reason for THA revision in 2020. One of the unique challenges faced by reconstruction surgeons performing revision THAs is the issue of acetabular bone loss. The aim of this paper is to present the role of custom acetabular reconstruction with marked bone loss for undergoing revision THA, using a local case study as an example. We described utilization of custom components to address the highly complex cases with Paprosky classification of III and above. Recent studies have shown comparable clinical results to conventional methods and improvement of postoperative patient-rated outcome scores. However, larger clinical trials focusing on the long-term outcomes in comparison to off-the-shelf components in complex acetabular revisions would be of merit.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Do We Physicians and Surgeons Deal With our Own Disease?","authors":"Rifat Latifi,&nbsp;Rahim Hirani,&nbsp;Abbas Smiley","doi":"10.52198/23.STI.42.GS1691","DOIUrl":"https://doi.org/10.52198/23.STI.42.GS1691","url":null,"abstract":"<p><p>It is a \"known secret\" that physicians and surgeons do not make good patients and neglect their own health by ignoring early warning signs of physical and psychological problems. Moreover, often, they seek help late. What are the reasons for this self-neglect? Is it because we think we are \"super humans,\" or we think that we will not get sick, cannot get sick, should not get sick, have no \"right\" to get sick, as we must care for others? Do we ignore ourselves because we must go to one more meeting, do one more thing, write or present one more paper, give one more lecture, or take the call even with a fever, cough, and chills? Why can't we call in sick? Is this the \"macho\" effect? Is this culture of denial pervasive everywhere, even though we should know better? Yes, it is! Don't we need to remember the advice given by airlines to put on an oxygen mask on yourself first before helping others? Unfortunately, many of us do not do it. In this article, we will present a personal reflection as an example and review how we physicians and surgeons neglect our own health, ignoring the early warning signs of physical and psychological problems, and how we often seek help late. We also discuss potential reasons for this becoming a \"norm\" for many of us. Lastly, we review measures taken by some healthcare systems to remedy this situation.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Achilles Tendon Repair Technique Utilizing a Bio-Composite Scaffold for a Sub-Acute Tear.","authors":"Harrison A Patrizio,&nbsp;Rex W Lutz,&nbsp;Charles J Middleton,&nbsp;Lauryn Bianco,&nbsp;Sean McMillan","doi":"10.52198/23.STI.42.OS1701","DOIUrl":"https://doi.org/10.52198/23.STI.42.OS1701","url":null,"abstract":"<p><p>Achilles tendon ruptures are prevalent musculoskeletal injuries accounting for 20% of all large tendon ruptures with a re-rupture rate of 2.1-8.8%. Ineffectual management of these injuries can lead to a significant loss in push-off strength and overall ankle function. The field of orthopedic surgery has shown an increasing interest in biologic augmentation. Encouraged by its success in various other applications, this approach holds promise for potentially enhancing outcomes in Achilles tendon repairs, especially in poor tendon tissue. The BioBrace® (ConMed, New Haven, Connecticut) is a biocomposite scaffold made of highly porous type I collagen and bioresorbable poly (L-Lactide) (PLLA) microfilaments. It can be applied in conjunction with Achilles tendon repair or reconstruction. It provides immediate strength to the augmented repair upon implantation and simultaneously promotes new, organized tissue growth throughout its resorptive phase. Here, we outline a technique to effectively augment an acute Achilles tendon repair utilizing the BioBrace® reinforced bio-inductive implant.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Bronchoscopic Management of Bronchopleural Fistula Following Pneumonectomy.","authors":"Christopher Manley,&nbsp;Nicole Kail,&nbsp;Stacey Su","doi":"10.52198/23.STI.42.CV1696","DOIUrl":"https://doi.org/10.52198/23.STI.42.CV1696","url":null,"abstract":"<p><p>Bronchopleural fistula (BPF) is a rare but significant cause of morbidity and mortality in cancer patients undergoing surgical lung resection. The mainstay of treatment for BPF is revision of surgical stump. We describe a case of persistent bronchopleural fistula treated with a novel combination of argon plasma coagulation and fibrin glue.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41110515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Sensor for Monitoring the Antimicrobial Activity of Wound Dressings for Both Surgical Site Infections (SSIs) and Chronic Wounds.","authors":"Marcus J Swann,&nbsp;Neville J Freeman,&nbsp;Fergus Watson,&nbsp;Stephen J Law,&nbsp;Steven L Percival","doi":"10.52198/23.STI.42.WH1692","DOIUrl":"https://doi.org/10.52198/23.STI.42.WH1692","url":null,"abstract":"<p><p>Antimicrobial impregnated wound dressings are a critical tool for the management, prevention, and control of surgical site infections (SSIs) and infected chronic wounds. However, the sustained therapeutic antimicrobial activity of the dressing when employed for extended periods cannot be readily determined in vivo. Consequently, dressings are changed frequently to ensure that their antimicrobial activity is maintained. Whilst frequent dressing changes allow the wound to be assessed, this is time-consuming and can cause disruption to the wound bed impairing the healing process. Furthermore, this increases medical costs for the patient and hospitals. This paper introduces a novel concept to monitor the therapeutic levels of an antimicrobial component within a wound dressing ensuring the wound dressing remains \"fit for purpose\" and avoiding indiscriminate use of antiseptics. This could help to inform clinicians whether the antimicrobial is still being delivered at therapeutic levels and as such when to change the dressing ensuring timely positive clinical outcomes. Silver has been used historically as an antimicrobial agent and is ubiquitous in current generations of antimicrobial wound dressings. However, its activity is complex due to the poor solubility of silver ions in the presence of chloride and the effect of complexation by other components in the dressing and wound ecosystem, not least by serum proteins. In this paper, we detail an electrochemical silver sensor (5D patent protected - WO2023275553A1), constructed using a platinum (Pt) nanoband array electrode, and characterise its response to silver ions. This is determined in the presence of bovine serum albumin (BSA) and simulated wound fluid (SWF) containing chloride and rationalised using atomic analysis of the composition of the SWF. The sensor response in SWF is compared with the antimicrobial activity of silver against Pseudomonas aeruginosa in the planktonic and biofilm state, as a function of the amount of silver nitrate added. At low concentrations, silver in SWF has good solubility but reduced antimicrobial effect due to binding of silver by BSA as shown by the sensor response. At intermediate concentrations, above 10ppm, the silver was efficacious on both planktonic microorganisms and biofilm impregnated with microorganisms and readily detected with the sensor. At high concentrations, silver precipitates and both the silver in solution and the sensor response plateaus. The data demonstrates how the sensor correlates with the antimicrobial activity of the silver in vitro and how this could be used to actively monitor antimicrobials in vivo.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Remote Physiologic and Therapeutic Monitoring Following Total Knee Arthroplasty.","authors":"Nipun Sodhi,&nbsp;Daniel Hameed,&nbsp;Robert L Barrack,&nbsp;Andrew M Schneider,&nbsp;Anil Bhave,&nbsp;Michael A Mont","doi":"10.52198/23.STI.42.OS1681","DOIUrl":"https://doi.org/10.52198/23.STI.42.OS1681","url":null,"abstract":"<p><strong>Introduction: </strong>Remote physiologic monitoring (RPM), or remote therapeutic monitoring (RTM), has grown exponentially for the management of chronic medical diseases in Medicare patients. More recently, the application of this technology has ventured into the orthopaedic arena, and more specifically, for total joint arthroplasty. Platforms to expedite this monitoring can provide continuous biodata feedback on digital biomarkers to patients and surgeons, which can potentially help improve and create novel patient-specific recovery pathways. Furthermore, various devices developed for this monitoring might help obviate the need for frequent emergency room visits, readmissions, and prolonged outpatient physical therapy sessions, as well as reduce complications and increase patient satisfaction scores after total joint arthroplasty surgery. However, while there are a number of potential benefits to technology for this type of care, its application following total knee arthroplasty has not been well-studied. Therefore, after an overview of the usage of RPM and RTM, the purpose of this study was to review the current literature regarding three common remote monitoring technologies: 1) smartphone apps; 2) wearables; and 3) combined smartphone apps and wearables. We also considered the potential financial implications of remote physiologic monitoring.</p><p><strong>Materials and methods: </strong>A comprehensive search of the PubMed, Cochrane Library, MedLine, and Web of Science databases was performed. Three main subgroups of monitoring devices were included for analysis: smartphone apps, wearable devices, and combined wearable plus smartphone app platforms. Searches focused on remote physiologic monitoring, patient-specific advantages, financial advantages, billing and coding options, as well as overall efficacy of platforms.</p><p><strong>Results: </strong>The current review found smartphone apps, wearables, and combined smartphone app and wearable platform technologies to be advantageous in the postoperative period following total knee arthroplasty. The wearable components can provide highly accurate and reproducible data, which the user-friendly smartphone app can relay to the patient so they can easily understand their progress. Additionally, through the apps, patients can directly access their surgical team. By constantly collecting and evaluating range of motion and functional data, the surgical team can identify if the patient is appropriately progressing through treatment or if further intervention is warranted.</p><p><strong>Conclusion: </strong>The incorporation of the remote physiologic monitoring devices during the post-total knee arthroplasty period shows strong promise as a progress-tracking modality. Published benefits include reduced physical therapy visits, decreased pain scores and reliance on opioids, increased activity levels as assessed by step counts, increased ability to follow less well-performing patients, reduce","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Postoperative Outcomes of Primary Total Hip Replacements: The Performance of Total Hip Replacement Procedures Leads to Worse Outcomes in Men.","authors":"Mitchell K Ng,&nbsp;Alex M Fong,&nbsp;Zhongming Chen,&nbsp;Adam Gordon,&nbsp;Matthew Magruder,&nbsp;Sandeep S Bains,&nbsp;Jeremy A Dubin,&nbsp;Daniel Hameed,&nbsp;Che Hang Jason Wong,&nbsp;Michael A Mont","doi":"10.52198/23.STI.42.OS1687","DOIUrl":"https://doi.org/10.52198/23.STI.42.OS1687","url":null,"abstract":"<p><strong>Introduction: </strong>The demand for primary total hip arthroplasty (THA) is expected to increase significantly in the coming years, and women are expected to account for the greatest proportion of this increased demand. The purpose of this study was to determine, using a national database, the effect of sex on 90-day outcomes in primary THA patients while matching for confounding variables. Specifically, we evaluated: (1) in-hospital lengths of stay; (2) 90-day readmission rates; (3) 90-day medical complications; (4) and total global 90-day episode-of-care (EOC) costs in men and women.</p><p><strong>Materials and methods: </strong>Using the 100% Medicare Standard Analytical Files (SAF), a query from January 1, 2005 to March 31, 2014 from a nationwide database was performed to analyze patients who received a primary THA. The series was divided into two cohorts: men (n=436,737) and women (n=436,737). Male and female patients were matched according to age and Elixhauser-Comorbidity Index (ECI). Uni- and multi-variable regression analyses were performed to analyze the effects of sex on in-hospital lengths of stay, 90-day readmission rates, 90-day medical complications, and total global 90-day EOC costs.</p><p><strong>Results: </strong>Men had greater overall 90-day medical complications compared to women following primary THA (1.28 vs. 1.19%, p<0.001). Men were found to have higher rates of acute kidney failure (0.12 vs 0.05%, p<0.0001), acute pancreatitis (0.02 vs. 0.01%, p<0.0001), cerebrovascular accidents (0.03 vs. 0.01%, p<0.0001), deep vein thromboses (0.06 vs. 0.04%, p<0.0001), and myocardial infarctions (0.02 vs. 0.01%, p<0.0001). Women were found to have higher rates of acute post-hemorrhagic anemiae (0.31 vs. 0.30%, p<0.001) and urinary tract infections (UTI; 0.40 vs. 0.28%, p<0.0001) compared to men. Men had shorter in-hospital lengths of stay (LOS) (3.42 vs. 3.54 days, p<0.001) but greater 90-day readmission rates (7.67 vs. 6.39% p<0.0001). Both cohorts had similar total global 90-day EOC costs ($14,869.85 ± $12,333.50 vs. $14,957.34 ± $10,915.61, p=0.36).</p><p><strong>Conclusion: </strong>Men undergoing THA have a greater number of overall 90-day medical complications and readmission rates while women have higher incidence of UTI, post-hemorrhagic anemia, and longer LOS. Understanding sex-based differences in complication rates and outcomes can help surgeons with preoperative counseling and targeted preoperative optimization.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}