scholarly journals A biomechanical analysis of different meshes for reconstructions of the pelvic floor in the porcine model

2021 ◽  
Author(s):  
Nadja Trageser ◽  
Axel Sauerwald ◽  
Sebastian Ludwig ◽  
Wolfram Malter ◽  
Kilian Wegmann ◽  
...  
Keyword(s):  
Porcine Model ◽  
Biomechanical Testing ◽  
Surgical Techniques ◽  
Maximum Load ◽  
Apical Part ◽  
Biomechanical Analysis ◽  
Fixation Method ◽  
Surgical Approaches ◽  
Fresh Cadaver ◽  
Significant Difference

Abstract Purpose Many different surgical approaches have been established for the repair of a pelvic organ prolapse. Especially in laparoscopic surgery, it is important to generate easy surgical techniques with similar stability. This study shall simplify the choice of mesh by evaluating three polypropylene meshes regarding their biomechanical properties. Methods Biomechanical testing was performed in the porcine model. The meshes are fixated on porcine fresh cadaver cervices after subtotal hysterectomy. The apical part of the mesh is fixated with parallel screw clamps at the testing frame. Forty-one trials were performed overall, subdivided into four subgroups. The groups differ in mesh type and fixation method. Maximum load, displacement at failure and stiffness parameters were evaluated with an Instron 5565® test frame. Results SERATEX® E11 PA (E11) showed the highest values for maximum load (199 ± 29N), failure displacement (71 ± 12 mm) and stiffness (3.93 ± 0.59 N/mm). There was no significant difference in all three evaluated parameters between SERATEX® B3 PA (B3) and SERATEX® SlimSling® with bilateral fixation (SSB). SERATEX® SlimSling® with unilateral fixation (SSU) had the lowest stiffness (0.91 ± 0.19 N/mm) and maximum load (30 ± 2 N) but no significant difference in displacement at failure. Conclusion All meshes achieved a good tensile strength, but the results of maximum load show that the E11 is superior to the other meshes. Through a bilateral fixation of SERATEX® SlimSling®, a simple operating method is generated without a loss of stability.

scholarly journals Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model

2021 ◽  
Author(s):  
Alina Katharina Jansen ◽  
Sebastian Ludwig ◽  
Wolfram Malter ◽  
Axel Sauerwald ◽  
Jens Hachenberg ◽  
...  
Keyword(s):  
Failure Mode ◽  
Reference Group ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Biomechanical Analysis ◽  
Fixation Method ◽  
Anterior Longitudinal Ligament ◽  
Fixation Methods ◽  
Fresh Cadaver ◽  
Significant Difference

Abstract Purpose There is a novel surgical procedure, called cervicosacropexy (CESA) and vaginosacropexy (VASA) to treat pelvic organ prolapse and a concomitant urgency and mixed urinary incontinence. As there is little experience with the tapes so far and literature is scanty, the aim of this study was to investigate biomechanical properties for the fixation of the PVDF-tapes with three different fixation methods in context of apical fixations. Methods Evaluation was performed on porcine, fresh cadaver sacral spines. A total of 40 trials, divided into 4 subgroups, was performed on the anterior longitudinal ligament. Recorded biomechanical properties were displacement at failure, maximum load and stiffness in terms of the primary endpoints. The failure mode was a secondary endpoint. Group 4 was a reference group to compare single sutures on porcine tissue with those on human tissue. Biomechanical parameters for single sutures on the human anterior longitudinal ligament were evaluated in a previous work by Hachenberg et al. Results The maximum load for group 1 (two single sutures) was 65 ± 12 N, for group 2 (three titanium tacks arranged in a row) it was 25 ± 10 N and for group 3 (three titanium tacks arranged in a triangle) it was 38 ± 12 N. There was a significant difference between all three groups. The most common failure mode was a “mesh failure” in 9/10 trials for groups 1–3. Conclusion The PVDF-tape fixation with two single sutures endures 2.6 times more load than titanium tacks arranged in a row and 1.7 times more load than titanium tacks arranged in a triangle. The presacral fixation with titanium tacks reduced surgical time compared to the fixation with sutures, nevertheless sutures represent the significantly stronger and cheaper fixation method.

scholarly journals Biomechanical properties of a novel biodegradable magnesium-based interference screw

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Marco Ezechieli ◽  
Hanna Meyer ◽  
Arne Lucas ◽  
Patrick Helmecke ◽  
Christoph Becher ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Interference Screw ◽  
Biomechanical Analysis ◽  
Interference Screws ◽  
Standard Implant ◽  
Biodegradable Magnesium

Magnesium-based interference screws may be an alternative in anterior/posterior cruciate ligament reconstruction. The well-known osteoconductive effects of biodegradable magnesium alloys may be useful. It was the purpose of this study to evaluate the biomechanical properties of a magnesium based interference screw and compare it to a standard implant. A MgYREZr-alloy interference screw and a standard implant (Milagro®; De Puy Mitek, Raynham, MA, USA) were used for graft fixation. Specimens were placed into a tensile loading fixation of a servohydraulic testing machine. Biomechanical analysis included pretensioning of the constructs at 20 N for 1 min following cyclic pretensioning of 20 cycles between 20 and 60 N. Biomechanical elongation was evaluated with cyclic loading of 1000 cycles between 50 and 200 N at 0.5 Hz. Maximum load to failure was 511.3±66.5 N for the Milagro® screw and 529.0±63.3 N for magnesium-based screw (ns, P=0.57). Elongations after preload, during cyclical loading and during failure load were not different between the groups (ns, P>0.05). Stiffness was 121.1±13.8 N/mm for the magnesiumbased screw and 144.1±18.4 for the Milagro® screw (ns, P=0.32). MgYREZr alloy interference screws show comparable results in biomechanical testing to standard implants and may be an alternative for anterior cruciate reconstruction in the future.

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

2018 ◽  
Vol 35 (01) ◽  
pp. 090-095 ◽  
Author(s):  
Mingyang Gray ◽  
Joseph Rousso ◽  
Matthew Hirsch ◽  
Joshua Rosenberg ◽  
Collin Rozanski
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Surgical Techniques ◽  
Determinants Of Health ◽  
Surgical Approaches ◽  
Delivery Of Care ◽  
Score Improvement ◽  
Significant Difference ◽  
Patient Reported

AbstractSocial determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.

scholarly journals Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions

2019 ◽  
Vol 81 (06) ◽  
pp. 686-693
Author(s):  
Haiyong He ◽  
Meiqin Cai ◽  
Manting Li ◽  
Lei Wei ◽  
Lun Luo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Modified Rankin Scale ◽  
Pterional Approach ◽  
Total Resection ◽  
Significant Difference

Abstract Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

scholarly journals An In Vivo Biomechanical Analysis of Syndesmotic Surgical Repair in Elite Athletes: Screw versus Suture Button Fixation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Stephen P. Canton ◽  
Tom Gale ◽  
Dukens LaBaze ◽  
William Anderst ◽  
MaCalus V. Hogan
Keyword(s):  
Patient Reported Outcomes ◽  
Screw Fixation ◽  
Tracking System ◽  
Surgical Techniques ◽  
Biomechanical Analysis ◽  
Fixation Method ◽  
Patient Specific ◽  
Suture Button ◽  
Patient Reported

Category: Trauma; Basic Sciences/Biologics Introduction/Purpose: Syndesmotic injuries account for 1-11% of all ankle sprains and are the most predictive factor of chronic ankle dysfunction 6 months after injury. Common surgical techniques include screw fixation (the ‘gold standard’) and dynamic fixation with a suture button device, which may lead to better clinical outcomes than rigid screw. To date, there are no studies comparing the in vivo biomechanics of suture button and rigid screw syndesmotic fixation, and no report of the correlations between biomechanics and patient outcomes. The goal of this study is to characterize the biomechanics of the native ankle syndesmosis, rigid screw fixation, suture button fixation, along with associated patient-reported outcomes. This study will elucidate mechanisms for improved patient-reported outcomes based on the fixation method. Methods: 6 patients (average age:23.6, 4M/1F, 2 suture button, 2 screw fixation and 1 hybrid) consented to participate in this IRB-approved study. After being medically cleared to return to full athletic participation, each participant performed seven movements (two single leg hops (straight and lateral), two alternating single-leg push-offs (front-to-back and side-to-side), vertical jumping, running, and walking within a biplane radiographic system (Figure 1). A validated volumetric model-based tracking system matched patient-specific 3D bone models (obtained from CT) to the synchronized biplane radiographs (Figure 1). Six degree of freedom ankle kinematics were determined for each movement and for the repaired and contralateral ankle of each participant. Patient reported outcomes were also measured using the Foot and Ankle Ability Measure (FAAM) and a Visual Analogue Scale (VAS). Results: The results show that the screw fixation (-0.99 mm) has greater tibiotalar lateral-medial translation of the injured side relative contralateral healthy side compared to the tightrope fixation (-0.73 mm) and hybrid (.05 mm). For the syndesmosis translation, the screw fixation (2.00 mm) also exhibits greater total magnitude of translation compared to the tightrope ((-0.44 mm) and hybrid fixation (1.02 mm). Conclusion: This study shows that the screw fixation exhibits greater translation of the syndemosis and lateral/medial translation of the Talus. This may suggest that this method is inferior to the tight-rope and hybrtid. Future studies will include all the motions and more subjects.

Influence of Surgical Techniques on Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-analysis

2020 ◽  
pp. 019459982097267
Author(s):  
Alessandro Vinciguerra ◽  
Alessandro Nonis ◽  
Antonio Giordano Resti ◽  
Diego Barbieri ◽  
Mario Bussi ◽  
...  
Keyword(s):  
Success Rate ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Clear Understanding ◽  
Endoscopic Endonasal ◽  
Significant Difference ◽  
Full Text Review ◽  
Data Source ◽  
The Mean

Objective Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique. Data Source A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020. Review Methods The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases. Results A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches ( P = .43). For mucosal flaps performed during END-DCR, the mean success rate was 89% (95% CI, 86%-91%) if mucosal flaps were used and 92% (95% CI, 88%-95%) if they were not used, with no statistical difference present ( P = .14). Conclusions Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome.

A Biomechanical Comparison of Composite Fixation and Veterinary Acetabular Plates for Stabilization of Acetabular Osteotomies in Dogs Loaded in Three-Point-Bending Fashion

1998 ◽  
Vol 11 (03) ◽  
pp. 152-157 ◽  
Author(s):  
D. D. Lewis ◽  
J. B. Madison ◽  
L. L. Blaeser ◽  
O. I. Ianz
Keyword(s):  
Yield Point ◽  
In Vitro Study ◽  
Maximum Load ◽  
Fixation Method ◽  
Three Point Bending ◽  
Mixed Breed ◽  
Significant Difference ◽  
Biomechanical Comparison ◽  
In Vitro Comparison

SummaryAn in vitro study comparing the biomechanical performance and accuracy of reduction for two methods of acetabular osteotomy repair in the dog is presented. Pelves were harvested from five adult mixed breed dogs weighing 25-30 kg. On e hemipelvis from each dog was repaired with the composite fixation and the contralateral hemipelvis was repaired with a 2.0 mm six hole veterinary acetabular plate. Eac h hemipelvis was loaded in a threepoint- bending fashion at a rate of 5 mm/min. An extensometer was placed over the dorso-medial surface of the acetabular osteotomy during loading. Reduction was significantly better for hemipelves stabilized with the composite fixation when compared to hemipelves stabilized with the 2.0 mm six hole veterinary acetabular plate. There was not a significant difference in bending stiffness, distractional stiffness, yield point and maximum load between repair groups.An in vitro comparison was made between a composite fixation method and acetabular plates for the stabilisation of acetabular osteotomies.

scholarly journals Do different surgical techniques in tibia pilon fractures change the results of the midterm?

2020 ◽  
Vol 50 (6) ◽  
pp. 1559-1565
Author(s):  
Vedat BİÇİCİ ◽  
İzzet BİNGÖL
Keyword(s):  
Surgical Techniques ◽  
Functional Results ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Pilon Fracture ◽  
Significant Difference ◽  
One Step ◽  
Type 3 ◽  
Pilon Fractures

Background/aim: Pilon fracture is difficult to treat fractures due to many complications that can develop after surgery. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques.Materials and methods: 89 pilon fractures of 87 patients treated for pilon fracture were evaluated. Patients were examined in 3 different groups (one step, two step surgery and Ilizarov). Functional results, postoperative complications and ankle AOFAS scores were evaluated.Results: The mean AOFAS score of the all patients was 77.67. There was no significant difference between 3 surgical techniques (P = 0,880). While skin complication was not seen in patients who underwent double-stage surgery and Ilizarov (0%); It was seen in 6 (15.7%) patients who underwent single-stage surgery. Treatment results were found to be better in type 1 and type 2 fractures, while in type 3 fractures (P = 0.004).Conclusion: Despite the different surgical approaches and implants applied, no difference was found between the midterm ankle functional results of the patients. Two-stage surgery and Ilizarov is a safe and effective treatment approach to reduce morbidity and early complications in pilon fractures.

scholarly journals The “Skipped Segment Screw” Construct: An Alternative to Conventional Lateral Mass Fixation–Biomechanical Analysis in a Porcine Cervical Spine Model

2017 ◽  
Vol 11 (5) ◽  
pp. 733-738
Author(s):  
Kedar Prashant Padhye ◽  
Yuvaraja Murugan ◽  
Raunak Milton ◽  
N. Arunai Nambi Raj ◽  
Kenny Samuel David
Keyword(s):  
Cervical Spine ◽  
Degrees Of Freedom ◽  
Motion Tracking ◽  
Biomechanical Testing ◽  
Biomechanical Study ◽  
Biomechanical Analysis ◽  
Lateral Mass ◽  
Six Degrees Of Freedom ◽  
Spine Stabilization ◽  
Significant Difference

<sec><title>Study Design</title><p>Cadaveric biomechanical study.</p></sec><sec><title>Purpose</title><p>We compared the “skipped segment screw” (SSS) construct with the conventional “all segment screw” (ASS) construct for cervical spine fixation in six degrees of freedom in terms of the range of motion (ROM).</p></sec><sec><title>Overview of Literature</title><p>Currently, no clear guidelines are available in the literature for the configuration of lateral mass (LM) screwrod fixation for cervical spine stabilization. Most surgeons tend to insert screws bilaterally at all segments from C3 to C6 with the assumption that implants at every level will provide maximum stability.</p></sec><sec><title>Methods</title><p>Six porcine cervical spine specimens were harvested from fresh 6–9-month-old pigs. Each specimen was sequentially tested in the following order: intact uninstrumented (UIS), SSS (LM screws in C3, C5, and C7 bilaterally), and ASS (LM screws in C3–C7 bilaterally). Biomechanical testing was performed with a force of 2 Nm in six degrees of freedom and 3D motion tracking was performed.</p></sec><sec><title>Results</title><p>The two-tailed paired <italic>t</italic>-test was used for statistical analysis. There was a significant decrease in ROM in instrumented specimens compared with that in UIS specimens in all six degrees of motion (<italic>p</italic>&lt;0.05), whereas there was no significant difference in ROM between the different types of constructs (SSS and ASS).</p></sec><sec><title>Conclusions</title><p>Because both configurations provide comparable stability under physiological loading, we provide a biomechanical basis for the use of SSS configuration owing to its potential clinical advantages, such as relatively less bulk of implants within a small operative field, relative ease of manipulating the rod into position, shorter surgical time, less blood loss, lower risk of screw-related complications, less implant-related costs, and most importantly, no compromise in the required stability needed until fusion.</p></sec>

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Sign in / Sign up

Export Citation Format

Share Document