Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Platelet Rich Plasma ◽  
Thigh Muscle ◽  
Muscle Injuries ◽  
Invasive Approach ◽  
Novel Approach ◽  
Duration Of Surgery ◽  
Biomaterial Application ◽  
Split Skin

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly. Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pres

scholarly journals Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†

2019 ◽  
Vol 56 (5) ◽  
pp. 968-975 ◽  
Author(s):  
Jonas Pausch ◽  
Eva Harmel ◽  
Christoph Sinning ◽  
Hermann Reichenspurner ◽  
Evaldas Girdauskas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Functional Mitral Regurgitation ◽  
Invasive Approach ◽  
Type Iiib ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract OBJECTIVES Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures. METHODS A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups. RESULTS Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041). CONCLUSIONS Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.

scholarly journals The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mark J. Russo ◽  
John Gnezda ◽  
Aurelie Merlo ◽  
Elizabeth M. Johnson ◽  
Mohammad Hashmi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Aortic Root ◽  
Plate Fixation ◽  
Aortic Surgery ◽  
Case Series ◽  
Ascending Aorta ◽  
The Body ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Novel Approach

Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system.Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together.Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (n=2), aortic root replacement (n=3), valve sparing root replacement (n=3), and replacement of the ascending aorta (n=11) and/or hemiarch (n=2). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections.Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.

scholarly journals A Simple and Novel Approach in Treating Congenital Symmastia (Using Tisseel in a 2-Step Approach)

2020 ◽  
Vol 6 ◽  
pp. 2513826X2095301
Author(s):  
Bismark Adjei ◽  
Susie Z. Yao ◽  
Ashraf Mostafa ◽  
Ommen Koshy
Keyword(s):  
Minimally Invasive ◽  
Fibrin Sealant ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Root Cause ◽  
Minimal Scarring ◽  
Novel Approach ◽  
Management Approaches

Introduction: Congenital symmastia is notoriously difficult to treat. Many management approaches have been reported but none seem to address the root cause of the anatomic deformity and may result in significant scarring. Method: We propose a minimally invasive approach to treating congenital symmastia with good results and minimal scarring by liposuction and use of a fibrin sealant. Conclusion: Liposuction of the pre-sternal area and injection of fibrin sealant as an adhesive with post-operative pressure garment support worked well to create and maintain a good cleavage.

scholarly journals Minimalistic reconstruction of exposed skull in a complex craniovertebral polytrauma

2021 ◽  
Vol 12 ◽  
pp. 248
Author(s):  
Srinjoy Saha
Keyword(s):  
Local Anesthesia ◽  
Soft Tissues ◽  
Platelet Rich Plasma ◽  
Skin Grafting ◽  
Long Term Results ◽  
Soft Tissue Thickness ◽  
Split Skin Grafting ◽  
Split Skin ◽  
Skull Bones

Background: In stable craniovertebral injuries complicated by polytrauma, rigorous spinal immobilization is essential for neuroprotection. Scalp and forehead reconstruction in these circumstances are safest when performed under local anesthesia, maintaining cervical immobilization. Case Description: A sizeable 10 × 6.5 cm forehead defect was reconstructed utilizing regenerative principles under local anesthesia and sedation in a 54-year-old woman. After adequate debridement of gangrenous soft tissues, exposed outer skull bones were trephined, forehead defect covered with a synthetic biomaterial, and the patient was discharged thereafter. Granulating neodermis regenerated within the biomaterial over the next 6 weeks. Weekly platelet-rich plasma injections along the wound margins facilitated wound regeneration. Dimensions reduced by two-thirds to 6.5 × 3.5 cm with wound regeneration and contraction, while granulating neodermis covered the remaining skull-bones. Split skin-grafting over the neodermis ensured satisfying long-term results, with similar color, texture, soft-tissue thickness, and sensation. Multiple occipitocervical, spinal, scapular, and rib fractures healed well with strict immobilization. Conclusion: Good long-term results were achieved with significantly reduced dangers, complications, hospitalization, and costs than traditional reconstructive flap surgeries. Minimalistic reconstruction utilizing tissue engineering and regenerative medicine principles appears beneficial for patients with grave spinal injuries.

Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor

2013 ◽  
Vol 19 (6) ◽  
pp. 708-715 ◽  
Author(s):  
Andre Nzokou ◽  
Alexander G. Weil ◽  
Daniel Shedid
Keyword(s):  
Minimally Invasive ◽  
Spinal Tumors ◽  
Subtotal Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Duration Of Surgery ◽  
Intradural Extramedullary ◽  
Mini Open

Object Resection of spinal tumors traditionally requires bilateral subperiosteal muscle stripping, extensive laminectomy, and, in cases of foraminal extension, partial or radical facetectomy. Fusion is often warranted in cases of facetectomy to prevent deformity, pain, and neurological deterioration. Recent reports have demonstrated safety and efficacy of mini-open removal of these tumors using expandable tubular retractors. The authors report their experience with the minimally invasive removal of extradural foraminal and intradural-extramedullary tumors using the nonexpandable tubular retractor. Methods A retrospective chart review of consecutive patients who underwent minimally invasive resection of spinal tumors at Notre Dame Hospital was performed. Results Between December 2005 and March 2012, 13 patients underwent minimally invasive removal of spinal tumors at Notre Dame Hospital, Montreal. There were 6 men and 7 women with a mean age of 55 years (range 20–80 years). There were 2 lumbar and 2 thoracic intradural-extramedullary tumors and 7 thoracic and 2 lumbar extradural foraminal tumors. Gross-total resection was achieved in 12 patients. Subtotal resection (90%) was attained in 1 patient because the tumor capsule was adherent to the diaphragm. The average duration of surgery was 189 minutes (range 75–540 minutes), and the average blood loss was 219 ml (range 25–500 ml). There were no major procedure-related complications. Pathological analysis revealed benign schwannoma in 8 patients and meningioma, metastasis, plasmacytoma, osteoid osteoma, and hemangiopericytoma in 1 patient each. The average equivalent dose of postoperative narcotics after surgery was 66.3 mg of morphine. The average length of hospitalization was 66 hours (range 24–144 hours). All working patients returned to normal activities within 4 weeks. The average MRI and clinical follow-up were 13 and 21 months, respectively (range 2–68 months). At last follow-up, 92% of patients had improvement or resolution of pain with a visual analog scale score that improved from 7.8 to 1.2. All patients with neurological impairment improved. The American Spinal Injury Association grade improved in all but 1 patient. Conclusions Intradural-extramedullary and extradural tumors can be completely and safely resected through a minimally invasive approach using the nonexpandable tubular retractor. This approach may be associated with even less tissue destruction than mini-open techniques, translating into a quicker functional recovery. In cases of foraminal tumors, by eliminating the need for facetectomy, this minimally invasive approach may decrease the incidence of postoperative deformity and eliminate the need for adjunctive fusion surgery.

scholarly journals Minimally Invasive Technique for the Reconstruction of the Medial Posteral Corner of the Knee associated to Anterior Cruciate Ligament. Functional Outcomes. Case Series

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Daniel Sini ◽  
Andres M. Jalil ◽  
Cristian A. Ferreyra ◽  
Mauricio Balla ◽  
Pablo S. Mancini ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Case Series ◽  
Anatomical Reconstruction ◽  
Collateral Ligament ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Acute Injuries ◽  
Anterior Cruciate

The medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) are the most commonly damaged ligaments of the knee. These are common injuries in young people and athletes. Joint laxity may contribute to long-term cartilage degeneration in the medial compartment and give functional limitations as a result of severe lesions of ACL and MCL treated conservatively. In severe acute injuries and chronic symptomatic instabilities should be indicated surgical treatment. The anatomical technique of medial reconstruction of the knee returns stability and allows a distribution of the normal load in patients with severe or chronic acute injuries. Anatomical reconstructions require large incisions and dissections of soft tissues, favoring the risk of contracture in flexion or extension. The technique we used in our series consists of a modification of Laprade’s anatomical technique through a non-anatomical triangular medial reconstruction of the knee, using a minimally invasive approach. Objectives: Show our technique in combined injuries of medial collateral ligament and ACL. Methods: Observational study, case series, retrospective. Population of five patients (N: 5) adults of both sexes, older than 18 years, with a diagnosis of combined lesion of MCL grade II - III with clinical and subjective instability and complete rupture of ACL that have been treated surgically with an anatomical reconstruction using arthroscopic approach of the ACL and a triangular reconstruction with the modified anatomical technique of LaPrade through a minimally invasive approach by the Orthopedics and Traumatology Service of the Reina Fabiola University Clinic. A descriptive statistical analysis of the data was performed. Results: A total of five patients with an average age of 27 ± 10.89 years were included. Of the total 4 (80%) correspond to the male sex. 100% of the cases presented a grade III lesion of the MCL. Patients were followed for an average of 16 ± 9.28 months. The ROM achieved by the patients was of full extension (0°) in 100% of them and flexion in average of 130° ± 14,14. All the cases presented exceeded 100° of flexion. Pain (EVA) 0.45 / 10. The maneuvers of the internal yawn and Lachman were negative in the whole series. According to Lysholm’s functional score, there was an improvement on average of 50.40 ± 6.23 points between the preoperative evaluation, which was initially poor (40.40 ± 9.91) and the post-operative excellent (90.80 ± 4.97). All the cases in the series presented a response to treatment greater than 84 points according to the Lysholm score, with an average good to excellent result in the total. Conclusion: Although there are anatomical techniques validated for the reconstruction of the MCL, the vast majority of them involves an extensive approach with the consequent damage of soft tissues derived from it. The current trend consists of a less aggressive treatment of LCM with an associated reconstruction of the ACL. The fact of performing an anatomical reconstruction with good initial and stable fixation, minimizing soft tissue damage, aims at early rehabilitation, decreasing the chances of rigidity. We did not observe any significant limitation in the ROM, nor post-surgical rigidity in our series of patients. All of them presented a good to excellent Lysholm score and no complications were observed. This type of construct is less invasive and more practical to perform, since it uses a fixation device less than the anatomical technique of LaPrade, which reduces the cost of surgery and decreases less the bone stock, on the other hand the surgical time is not prolonged. Other advantages are that it consists of a short construct with low risk of voltage loss, with a favorable isometry and that is fast, easy to perform and reproducible.

A pilot study on the efficacy and safety of a minimally invasive surgical and anesthetic approach for ventricular assist device implantation

2017 ◽  
Vol 41 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Jonida Bejko ◽  
Demetrio Pittarello ◽  
Gianclaudio Falasco ◽  
Guido Di Gregorio ◽  
Vincenzo Tarzia ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ventricular Assist Device ◽  
Surgical Techniques ◽  
Minimally Invasive Approach ◽  
Assist Device ◽  
Ventricular Assist ◽  
Invasive Approach ◽  
Invasive Group ◽  
Device Implantation ◽  
Duration Of Surgery

Background: The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation. Methods: 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients). Results: The minimally invasive approach allowed faster postoperative recovery by significantly reducing the duration of surgery (p<0.05), anesthesia (p<0.05), mechanical ventilation (p<0.05), inotropic support (p<0.05), ICU and in-hospital stay (p<0.05), and time to first mobilization (p<0.05). No case of epidural hematoma was observed. Eleven patients died (16%) at 30 days, 3 in the mini-invasive group (7.3%) and 8 in the invasive group (29.6%). Conclusions: Minimally invasive approaches play a substantial role in VAD surgery by facilitating faster recovery, which is important for patients at very high risk.

scholarly journals VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Sónia Ribas ◽  
Ana Peixoto Pereira ◽  
Conceição Antunes
Keyword(s):  
Minimally Invasive ◽  
Abdominal Cavity ◽  
Lumbar Hernia ◽  
Barbed Suture ◽  
Invasive Approach ◽  
Incisional Hernias ◽  
Tapp Repair ◽  
Duration Of Surgery ◽  
Invasive Techniques

Abstract Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

Platelet rich plasma as a minimally invasive approach to uterine prolapse

2017 ◽  
Vol 104 ◽  
pp. 97-100 ◽  
Author(s):  
E.L. Chrysanthopoulou ◽  
V. Pergialiotis ◽  
D. Perrea ◽  
S. Κourkoulis ◽  
C. Verikokos ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Uterine Prolapse ◽  
Platelet Rich Plasma ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency

2016 ◽  
Vol 98 (1) ◽  
pp. 24-28
Author(s):  
David van Dellen ◽  
Muneer Junejo ◽  
Hussein Khambalia ◽  
Babatunde Campbell
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Intraoperative Complications ◽  
Late Complications ◽  
Primary Patency ◽  
Arteriovenous Fistulae ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
Novel Approach ◽  
One Year

Introduction Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous ‘real estate’ but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. Methods A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. Results Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). Conclusion Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity.

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