Integran käyttö Helsingin yliopistollisen sairaalan plastiikkakirurgian yksikössä 2015-2020

Integra (Integra LifeSciences, Plainsboro, New Jersey, USA) on kahdesta kerroksesta koostuva soluton keinoiho. Integra kehitettiin alun perin palovammapotilaita varten, joilla oli laajat, syvät vauriot eikä riittävästi tervettä ihoa jäljellä omaihonsiirrettä varten. Nykypäivänä Integraa käytetään pehmytkudoksen rekonstruktiossa trauman jälkeen, syövän poiston yhteydessä ja arpien revisioon kaikilla anatomisilla alueilla. Tutkimukseen kerättiin retrospektiivisesti tietoa potilasasiakirjamerkinnöistä Uranus-potilastietojärjestelmästä. Aineiston potilaat saivat Integra-tekoihonsiirteen Helsingin yliopistollisen sairaalan plastiikkakirurgian yksikössä vuosina 2015-2020 joko palovamman tai kasvojen tai päänalueen tyvisolu- tai okasolusyövän takia. Tutkimuksessa huomioitiin potilaan ikä, sukupuoli ja perussairaudet. Lisäksi kerättiin tietoa leikkausindikaatiosta, anatomisesta alueesta, leikatun alueen koosta, haavapohjasta ekskision jälkeen, haavan suojauksesta leikkauksen jälkeen, antibioottien käytöstä ja lopputuloksesta. Potilaita oli yhteensä 63, joista palovammapotilaita oli 25 ja ihosyöpäpotilaita 38. Leikattuja alueita, joille asetettiin Integra oli yhteensä 76. Peitetyistä alueista 47 parantui todistetusti, joista 44 sai autograftin ja 3 epitelisoitui spontaanisti. Palovammapotilaiden ja ihosyöpäpotilaiden parantumisen keston välillä ei ollut tilastollisesti merkittävää eroa. Potilaan sukupuolella, iällä tai perussairauksilla ei ollut yhteyttä parantumisajan kanssa. Kirjallisuudessa Integran tavallisin komplikaatio on infektio. Tässä tutkimuksessa kaikista Integralla peitetyistä alueista 14,5% infektoitui. Infektiolle itsenäisesti altistavia tekijöitä ei todettu. Infektio korreloi tilastollisesti merkittävästi pidentyneen toipumisajan kanssa. Integran käyttö on perusteltua tapauksissa, jossa omaihonsiirre ei ole mahdollinen, potilaan iästä, sukupuolesta ja perussairauksista riippumatta. Integra on toimiva ratkaisu sekä palovamma- että ihosyöpäpotilailla, haavan sijainnista, syvyydestä tai pinta-alasta riippumatta.Integra (Integra LifeSciences, Plainsboro, New Jersey, USA) är en acellulär konstgjord hud som består av två lager. Integra utvecklades ursprungligen med tanke på brännskadepatienter med så stora och djupa skador att de inte hade tillräckligt med frisk hud kvar för ett autogent hudtransplantat. Nuförtiden används Integra i rekonstruktion av mjukvävnader efter trauma, i samband med borttagning av cancer och till revision av ärrvävnad på alla anatomiska områden. Till studien samlades det retrospektivt data från patientjournalerna i patientdatasystemet Uranus. Patienterna fick Integra konstgjort hudtransplantat i Helsingfors universitetssjukhus plastikkirurgiska enhet under åren 2015–2020 antingen för att vårda brännskador eller ansiktets eller hjässans basalcells- eller skivepitelcancer. I forskningen beaktades patientens ålder, kön och grundsjukdomar. Dessutom samlades det information om operationsindikationen, skadans anatomiska läge, det opererade områdets storlek, sårbottnens egenskaper efter excision, hur såret skyddades efter operationen, användning av antibiotika och om slutresultatet. Patienterna var sammanlagt 63 stycken, varav 25 var brännskadepatienter och 38 hudcancerpatienter. Sammanlagt 76 stycken områden täcktes med Integra. Av de opererade områdena läkte bevisligen 47 stycken, av vilka 44 fick ett autogent hudtransplantat och 3 genomgick epitelisering spontant. Skillnaden i läkningstiderna mellan brännskade- och hudcancerpatienterna var inte statistiskt signifikant. Patienternas ålder, kön eller grundsjukdomar påverkade inte läkningstiden. Inom litteraturen är Integras vanligaste komplikation infektion. I den här studien infekterades 14,5% av alla Integra områden. Faktorer som självständigt skulle ha utsatt för infektion hittades inte. Infektion korrelerade statistiskt signifikant med en förlängd läkningstid. Användning av Integra är befogat i patientfall, där användning av autogent hudtransplantat inte är möjligt, oberoende av patientens ålder, kön och grundsjukdomar. Integra är en fungerande lösning både för brännskade- och hudcancerpatienter, oberoende av sårets anatomiska läge, djuphet eller storlek.

Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor

Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. This report represents the first published case of an intraosseous foreign body granuloma in the humeral head after arthroscopic rotator cuff tear fixation with a poly-l-lactide (PLLA) suture anchor. A 48-year-old female patient presented with pain in her right shoulder. A refixation of her right supraspinatus tendon with a biodegradable suture anchor was performed 11 months ago at an external hospital. Laboratory tests showed normal values for C-reactive protein, leukocytes and the erythrocyte sedimentation rate. No signs of infection or instability were noted. The visual analogue scale (VAS) was 8, the simple shoulder test (SST) was 4 and the American shoulder and elbow surgeons score (ASES) was 44. Plain radiographs showed high lucency in the area of the tuberculum majus. MRI showed an intra- and extraosseous mass surrounded by fluid in this area. Surgical care involved arthroscopic debridement and removal of the suture anchor. Histological examination revealed a foreign body granuloma. At the 18-month follow-up the patient was nearly pain-free. The VAS was 2, SST was 10 and ASES was 88. Foreign body granulomas are a well known but rarely described complication that arises after the use of biodegradable suture anchors in shoulder surgery. Every patient presenting with shoulder pain after usage of a biodegradable fixation material should be evaluated closely. Orthopaedic surgeons should be aware of the possibility of delayed foreign body reactions, especially after using PLLA anchors

One Screening Magnetic Resonance Imaging Sequence in Evaluation of Chondral and Meniscal Lesions of the Knee − A Pilot Study

This prospective study aimed to evaluate if chondral and meniscal lesions in symptomatic knees of osteoarthritis patients can be reliably identified using only one sagittal dual-echo MRI (Magnetic Resonance Imaging) sequence. MRI was performed on 13 patients after knee arthroscopy due to knee pain and clinically suspected osteoarthritis using a 1.5-Tesla scanner with knee coil and a sagittal dual-echo turbo spin-echo PD (Proton Density)- and T2-weighted sequence. The MRI and arthroscopic findings were then compared. Of 65 articular surfaces, 47 were damaged. For articular cartilage lesions, the overall sensitivity of MRI was 46.8%, specificity 72.2%, and diagnostic accuracy 53.9%, and for meniscal ruptures 81.2%, 66.7%, and 73.1%, respectively. The present study showed that the reliability of screening MRI of knees using only one sagittal dual-echo sequence does not suffice for diagnosis of chondral or meniscal lesions, and should therefore not replace routine knee MRI or diagnostic arthroscopy

A biodegradable antibiotic delivery system based on poly-(trimethylene carbonate) for the treatment of osteomyelitis

Background and purpose Many investigations on biodegradable materials acting as an antibiotic carrier for local drug delivery are based on poly(lactide). However, the use of poly(lactide) implants in bone has been disputed because of poor bone regeneration at the site of implantation. Poly(trimethylene carbonate) (PTMC) is an enzymatically degradable polymer that does not produce acidic degradation products. We explored the suitability of PTMC as an antibiotic releasing polymer for the local treatment of osteomyelitis

Tissue Restoration After Implantation of Polyglycolide, Polydioxanone, Polylevolactide, and Metallic Pins in Cortical Bone: An Experimental Study in Rabbits

Peer reviewe

The Evaluation of the Possibilities of Using PLGA Co-Polymer and Its Composites with Carbon Fibers or Hydroxyapatite in the Bone Tissue Regeneration Process – in Vitro and in Vivo Examinations

Synthetic polymers belonging to the aliphatic polyester group have become highly promising biomaterials for reconstructive medicine. The purpose of the present work is a biological evaluation of lactide-glycolide co-polymer (PLGA) and its composites with carbon fibers (PLGA+CF) or hydroxyapatite (PLGA+HA). The cytotoxicity of the evaluated materials towards hFOB 1.19 human osteoblast-like cells was assessed. Moreover, during the one-year contact of the assessed materials with living osseous tissue, the progress of bone formation was analyzed and the accompanying process of the materials’ degradation was evaluated. The materials under evaluation proved to be biocompatible

Axial forces and bending moments in the loaded rabbit tibia in vivo

<p>Abstract</p> <p>Background</p> <p>Different animal models are used as fracture models in orthopaedic research prior to implant use in humans, although biomechanical forces can differ to a great extend between species due to variable anatomic conditions, particularly with regard to the gait. The rabbit is an often used fracture model, but biomechanical data are very rare. The objective of the present study was to measure axial forces, bending moments, and bending axis directly in the rabbit tibia <it>in vivo</it>. The following hypothesis was tested: Axial forces and bending moments in the mid-diaphysis of rabbit tibia differ from other experimental animals or indirectly calculated data.</p> <p>Methods</p> <p>A minifixateur system with 4 force sensors was developed and attached to rabbit tibia (<it>n </it>= 4), which were subsequently ostectomised. Axial forces, bending moments and bending angles were calculated telemetrically during weight bearing in motion between 6 and 42 days post operation.</p> <p>Results</p> <p>Highest single values were 201% body weight [% bw] for axial forces and 409% bw cm for bending moments. Whereas there was a continous decrease in axial forces over time after day 10 (<it>P </it>= 0.03 on day 15), a decrease in bending moments was inconsistent (<it>P </it>= 0.03 on day 27). High values for bending moments were frequently, but not consistently, associated with high values for axial forces.</p> <p>Conclusion</p> <p>Axial forces in rabbit tibia exceeded axial forces in sheep, and differed from indirectly calculated data. The rabbit is an appropriate fracture model because axial loads and bending moments in rabbit tibia were more closely to human conditions than in sheep tibia as an animal model.</p