Search Results (209)

Background and Objectives: This study aims to assess the postoperative outcomes and complications of sutureless and sutured aortic valve replacement in patients with infective endocarditis. Materials and Methods: A total of 58 patients who underwent redo aortic valve replacement for bacterial or non-bacterial endocarditis between January 2018 and March 2023 were included in our study. Surgical procedures were performed through a full median sternotomy due to redo cases and to provide optimal access. Demographic characteristics, operative times, postoperative complications and some echocardiographic data were compared. All cases were meticulously evaluated preoperatively by a cardiac team to select the best treatment option. Results: The mean ICU length of stay was significantly shorter in the sutureless valve group at 5.4 ± 3.9 days compared to 7.9 ± 4.1 days in the sutured valve group (p = 0.029). However, the sutureless group had a mean operation time of 164.7 ± 37.3 min, while the sutured group had a mean operation time of 197.7 ± 45.6 min (p = 0.044). Again, the difference in cardiopulmonary bypass times between the two groups was statistically significant (p = 0.039). And again, four (14.2%) patients in the sutureless group underwent reoperation due to bleeding, while eight (26.6%) patients in the sutured group underwent postoperative bleeding control (p = 0.048). Conclusions: Our study suggests that sutureless aortic valve replacement may offer advantages in terms of operative efficiency and postoperative recovery compared to conventional sutured valves, with some significant differences in terms of some complications. Full article

Three-dimensional (3D) printing is an advanced technology for accurately understanding anatomy and supporting the successful surgical management of complex congenital heart disease (CHD). We aimed to evaluate whether our super-flexible 3D heart models could facilitate preoperative decision-making and surgical simulation for complex CHD. The super-flexible heart models were fabricated by stereolithography 3D printing of the internal and external contours of the heart from cardiac computed tomography (CT) data, followed by vacuum casting with a polyurethane material similar in elasticity to a child’s heart. Nineteen pediatric patients with complex CHD were enrolled (median age, 10 months). The primary endpoint was defined as the percentage of patients rated as “essential” on the surgeons’ postoperative 5-point Likert scale. The accuracy of the models was validated by a non-destructive method using industrial CT. The super-flexible heart models allowed detailed anatomical diagnosis and simulated surgery with incisions and sutures. Thirteen patients (68.4%) were classified as “essential” by the primary surgeons after surgery, with a 95% confidence interval of 43.4–87.4%, meeting the primary endpoint. The product error within 90% of the total external and internal surfaces was 0.54 ± 0.21 mm. The super-flexible 3D heart models are accurate, reliable, and useful tools to assist surgeons in decision-making and allow for preoperative simulation in CHD. Full article

Background/Objectives: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%. While direct suturing remains the gold standard, it has a failure rate of 5–10%. Various materials and techniques have been used to enhance dural closure. This study aims to assess the effectiveness of non-penetrating titanium clips (AnastoClip^®) for dural closure in intradural spinal lesion surgeries. Methods: A prospective analysis was conducted on 272 patients who were operated on for intradural spinal lesions from August 2017 to December 2023. Dural closure was performed using non-penetrating titanium clips with sealant, and, in select cases, autologous grafts. Postoperative care included early mobilization and routine MRI to assess outcomes. A comparative analysis was performed with a cohort of 81 patients treated with traditional sutures. Results: Among the 272 patients, postoperative CSF leaks occurred in 32 cases (11.76%), requiring various management approaches. Thirteen cases required surgical revision, while others resolved with external lumbar drainage or fluid aspiration. Compared to the suture group, which had a fistula rate of 23.46%, the titanium clip group had a significantly lower fistula rate. Logistic regression analysis did not find statistically significant associations between fistula risk and clinical factors. Conclusions: Non-penetrating titanium clips provide an effective alternative to sutures for dural closure, reducing CSF leak rates. They preserve dural integrity, reduce operative time, and avoid imaging artifacts, making them a viable advancement in spinal surgery with outcomes comparable to, or better than, traditional techniques. Full article

Silk and polycaprolactone (PCL), derived from natural and synthetic sources, respectively, are suture materials commonly used in surgery. Beyond their application in sutures, they are also compelling subjects in regenerative medicine and tissue engineering. This study evaluated the effects of degummed silk microfibers compared to electrospun PCL microfibers of a similar diameter on chondrocyte behavior. The two types of microfibers were analyzed using scanning electron microscopy (SEM), real-time PCR, Western blotting, and DMMB analysis. The results demonstrated that the silk microfibers exhibited a higher proliferative cell rate over time compared to the PCL microfibers. Additionally, the expression of chondrogenic phenotypes was significantly upregulated, while the marker for hypertrophic chondrocytes—type X collagen—was downregulated in cell-laden silk microfibers compared to cell-laden PCL microfibers. These findings suggest that natural degummed silk microfibers may be a viable option for repairing damaged cartilage in the future of orthopedic surgery and bioengineering. Full article

Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful in maintaining intact cortical bone, is examined in the context of a bone defect. Materials and Methods: After an atraumatic extraction of a damaged tooth, a vestibular bone fenestration was discovered in the 62-year-old male patient. To shield the defect, a non-resorbable PTFE membrane (OSSEO GUARD by Zimmer Biomet) was positioned between the mucosa and the fenestration site. A resorbable porcine gelatin sponge (SPONGOSTAN^TM) was used to achieve hemostasis, and a 5/0 PGCL absorbable suture was used to close the wound. A CBCT scan was performed, and a dental implant was inserted after 4 months. Results: After 4 months, the case demonstrated positive results, with full cortical remodeling and preservation of the original bone proportions. The fenestration completely healed, proving that the PI approach works even in the presence of bone flaws in cortical bone that is still intact. Conclusions: This is the first case report that shows that vestibular bone fenestration can be successfully treated with the PI approach. It has now been demonstrated that the procedure, which hitherto needed an undamaged cortical bone to work, can help bone abnormalities to repair completely. These results imply that the PI technique is a flexible and useful approach that provides predictable results in dental surgery for treating different types of alveolar bone abnormalities. Its use might be expanded with more study to include bone dehiscence treatment. Full article

Microimplant-assisted rapid palatal expansion (MARPE) is a technique widely used to treat transverse discrepancies in adult patients. The present study aims to examine how age, sex, maxillary width, and suture bone density might influence MARPE efficacy. It also analyzes bone density variations across the midpalatal suture regions. Materials and Methods: This retrospective study included 30 adult patients who underwent MARPE treatment. Pre- and post-treatment CT scans were analyzed to quantify the maxillary width and bone density measured in Hounsfield units (HUs) in the anterior, middle, and posterior nasal spine regions. Statistical analyses were carried out and included descriptive statistics, t-tests, and effect size calculations. Results: Younger patients (age 22.13 ± 4.58) had significantly higher success rates compared to older patients (aged 25.66 ± 4.67). No significant differences were found regarding sex or the initial maxillary width. Lower bone density in the middle and posterior nasal spine regions was correlated with higher success rates. Data showed that the anterior nasal spine exhibited higher bone density, but this finding did not affect treatment outcomes significantly. Conclusions: Age seems to be a crucial factor in MARPE success, with younger patients showing better outcomes. Regarding bone density, results showed that its values in the middle and posterior nasal spine regions could be a determinant of treatment success. On the contrary, sex and the initial maxillary width did not appear to affect outcomes. These findings emphasize the importance of preoperative assessments and the consideration of individual anatomical variations for optimal MARPE treatment planning. Full article

Regenerated cellulose fibers are a highly adaptable biomaterial with numerous medical applications owing to their inherent biocompatibility, biodegradability, and robust mechanical properties. In the domain of wound care, regenerated cellulose fibers facilitate a moist environment conducive to healing, minimize infection risk, and adapt to wound topographies, making it ideal for different types of dressings. In tissue engineering, cellulose scaffolds provide a matrix for cell attachment and proliferation, supporting the development of artificial skin, cartilage, and other tissues. Furthermore, regenerated cellulose fibers, used as absorbable sutures, degrade within the body, eliminating the need for removal and proving advantageous for internal suturing. The medical textile industry relies heavily on regenerated cellulose fibers because of their unique properties that make them suitable for various applications, including wound care, surgical garments, and diagnostic materials. Regenerated cellulose fibers are produced by dissolving cellulose from natural sources and reconstituting it into fiber form, which can be customized for specific medical uses. This paper will explore the various types, properties, and applications of regenerated cellulose fibers in medical contexts, alongside an examination of its manufacturing processes and technologies, as well as associated challenges. Full article

Background/Objectives: The general use of triclosan-coated suture material (TCSM) for wound closure to prevent surgical site infections (SSIs) remains controversial. There is no conclusive evidence in the literature to support this and recommendations by professional organizations are contradictory. Therefore, the main objective of the study was to evaluate the 30-day rate of surgical site infections (SSIs) after elective open abdominal surgery using triclosan-coated versus uncoated running sutures (NCSM) for skin closure. Methods: This prospective, randomized, double-blinded study enrolled patients scheduled for open elective abdominal surgery, intraoperatively assigned to either the use of triclosan-coated or non-coated sutures for skin closure. The follow up was 30 days after surgery to detect SSIs. Secondary endpoints were wound dehiscence and reoperation rate due to wound dehiscence within 30 days, all-cause 30-day mortality and length of hospital stay. Potential risk factors for poor wound healing were evaluated in multivariate analysis. Data were analyzed in an intention to treat analysis. Results: In total, 364 patients (171 males [47%]) were randomized, 182 in either group. Six underwent urgent reoperation prior to first visit and were excluded from analysis. In the full analysis set (FAS), 358 were analyzed. SSI within 30 days occurred in 22 [12.2%] patients in the control group compared to 32 [18%] in the study group. The risk difference was not statistically significant (5.8%; 95% confidence interval (CI) −1.6–13.2%; p = 0.128). The wound dehiscence rate within 30 days was 14 of 179 [7.8%] in the NCSM group vs. 19 of 178 [10.7%] in the TCSM group. The difference in re-operation rates due to wound dehiscence was 0 of 179 [2.8%] vs. 5 of 178 [2.8%] in either group and not statistically significant (p = 0.0706). Among all patients recruited, 8 died within 30 days after surgery. Three of them died before the first assessment of the primary endpoint on day 3 and were therefore excluded from the FAS. The 30-day mortality rate was 2 of 180 [1.1%] in the NCSM group vs. 3 of 178 [1.7%] in the TCSM group. The majority of SSIs occurred in the superficial layer of the wound in both study groups (8.9% vs. 9.6%). The median [inter quartile range (IQR)] length of hospital stay was 13 [9.0, 19.2] days in the NCSM group vs. 11 [9.0, 16.8] days in the TCSM group There was a tendency towards shorter hospitalization in the study group (0.72 days [6%]). Conclusions: Our prospective randomized controlled trial could not confirm the superiority of TCSM for skin closure after elective open abdominal surgery in terms of SSI rates in a 30-day follow up period. Therefore, based on our results, a general recommendation for its use in all surgical fields cannot be justified. Full article

Background and Objectives: This study evaluated the outcomes of single open-flap debridement, open-flap debridement (OFD) plus resorbable membrane placement, and OFD with resorbable membrane placement plus platelet-rich fibrin (PRF) in terms of periodontal clinical parameters and glycated hemoglobin (HbA1c) levels in 24 adult patients with stage 3 grade C periodontitis and type II diabetes mellitus. Materials and Methods: The primary outcome measure for this study was the clinical attachment level (CAL); secondary outcomes included additional periodontal parameters, such as the plaque index (PI), bleeding on probing (BOP), probing depth (PD), as well as glycated hemoglobin (HbA1c) levels to evaluate the systemic impact of the treatments on glycemic control. The parameters were assessed before and at three and six months post-surgery. In Group A, the flap was sutured closed; in Group B, an absorbable collagen membrane was placed over the defect; and in Group C, PRF was utilized in the defect, with two additional PRF membranes used to cover the defect. The wound healing index (WHI) was recorded at 7 and 14 days after the surgery. Results: The initial findings indicated no significant differences in the periodontal parameters among the three groups. However, improvements in the PD and CAL were most notable in Group C, followed by Group B, with Group A showing the slightest improvement. At six months, there was a highly significant difference in the CAL (p < 0.001). Group C (4.92 ± 0.35) and Group B (4.99 ± 0.31) demonstrated the most significant improvements in the CAL compared to Group A (5.89 ± 0.57). At seven days post-surgery, Group C demonstrated significant healing, with 85% of the sites showing complete healing. By the 14-day mark, all sites in Group C indicated complete healing. Although the HbA1c values did not exhibit statistically significant differences among the groups at baseline, at the 6-month evaluation, all groups showed significantly lower values than baseline. However, the comparison between groups revealed significantly improved values for Group C. Conclusions: The study’s results suggest that PRF is an exceptional material for infrabony defects treatment and notably improves HbA1c levels. Full article

Zircon U-Pb dating, rock geochemistry, Sr-Nd-Pb, and zircon Hf isotope analyses were conducted on the ultrabasic and basic rocks of ophiolites in the Sabah area (Borneo, SE Asia). The zircon U-Pb ages of ultrabasic and basic rocks range from 248 to 244 Ma, indicating that the ophiolites already existed in the early Triassic. The rare earth elements of basic rocks in Central Sabah show N-MORB-type characteristics and E-MORB-type characteristics in the northwest and southeast. The ε_Nd(t) values of basic rocks range from 3.66 to 8.73, and the ε_Hf(t) values of zircon in ultrabasic rocks are between −10.2 and −6.1. Trace element analysis shows that the magmatic source was influenced by melts and fluids from the subducting plate of the Paleo-Tethys Ocean. The tectonic evolution of the Sabah area can be traced back to the Early Triassic. At that time, the fast subduction of the Paleo-Tethys Ocean plate and the retreating of the Paleo-Pacific plate resulted in the upwelling of mantle material in relatively small extensional settings, leading to the formation of the ophiolites. From the Jurassic to the Early Cretaceous, the Paleo-Pacific plate was intensely subducted, and the ophiolite intrusion in the Sabah area moved to the continental crust of South China or the Sundaland margin as fore-arc ophiolites. From the Late Cretaceous to the Miocene, with the expansion of the Proto-South China Sea and South China Sea oceanic crust, the ophiolites in the Sabah area drifted southward with microplate fragments and sutured with East Borneo. Full article

Introduction: Intraoperative fluid management is one of the most important factors affecting optimal perfusion in the microcirculatory area in patients that undergo flap surgery. While insufficient fluid administration in the intraoperative period leads to flap complications and organ dysfunction, volume load can cause complications such as edema in the denervated flap tissue, the opening of the sutures, or fat necrosis. The Infrared Fluorescent Angiography Perfusion Evaluation Device (SPY) is one of the many noninvasive techniques that evaluate the well-being of microcirculation at the tissue level. This device monitors and scores the perfusion distribution in the flap area. This retrospective study aimed to investigate the effect of fluid resuscitation in head and neck free flap transfer surgery on flap quality and patient outcomes according to the change in SPY scores. Material and Method: This study included 39 ASA I–II patients who were aged 18–60 years and underwent simultaneous free flap reconstruction of the head and neck between 2015 and 2021. Patients’ blood pressure, body temperature, hemoglobin, pH, and lactate values were recorded at both baseline and end of the operation. Also, the SPY “Infrared Fluorescent Angiography Perfusion Evaluation Device” scores, the amount of intraoperative fluid and transfusion, bleeding and urine output, and the duration of mechanical ventilation, anesthesia and surgery, and the duration and amount of drainage, the length of stay in hospital and intensive care unit, and the presence of flap infection, detachment, necrosis and loss, and re-exploration rate were recorded for the patients. Results: The difference between the first and last measured SPY values was observed to be positively correlated with the length of stay in the hospital and intensive care unit and the duration of drainage. There was a positive correlation between the length of stay in the hospital and intensive care unit and the duration of drainage, the amount of drainage, as well as the duration of anesthesia and the duration of surgery (p < 0.001). A positive correlation was found between the amount of drainage and the amount of crystalloid solution administered (r = 0.36, p < 0.05). In patients with flap infection, the difference between SPYfirst and SPYlast, the duration of anesthesia, and the duration of surgery were significantly higher. The amount of crystalloid solution given and bleeding and the duration of anesthesia and surgery were found to be significantly higher in mechanically ventilated patients (p < 0.05). Conclusions: It has been concluded that SPY-guided fluid management can be beneficial in preventing morbidities, such as extended hospital and intensive care stay, by reducing flap infection, mechanical ventilation duration, and drainage, with early diagnosis of insufficient perfusion. Full article

Background and Objectives: Periodontal therapy aims to arrest the progression of periodontal diseases and possibly to regenerate the periodontal apparatus. To shift healing from repair to regeneration, the blood clot that fills the periodontal defect and remains in contact with structures such as tooth root, mucosa and bone needs to be stable, which is a reason why the treatment of non-containing periodontal bone defects, in which the clot may undergo displacement, is challenging. The gingival soft tissue, properly sutured, may act as a wall for blood clot stabilization. Knowledge on the response of the blood clot to stress and how it might vary according to the characteristics of the tissues it gets in contact with might be deepened. The aim of this study was to investigate in vitro, by means of a micro-loading device, the response of the complex formed by a blood clot and diverse tissues, simulating those involved in periodontal regeneration, to a displacing tensile test. Materials and Methods: Experimental samples made of two layers of either hard dental tissues, cancellous bone or oral mucosa, between which fresh blood was interposed, underwent a debonding experiment by means of a micro-loading device that measured their response to uniaxial tensile stress. Results: The peak of tensile stress and the overall work needed for the complete rupture of the clot’s fibrin filaments were significantly higher for hard dental tissues than for other tissues. However, mucosa sustained the highest maximal strain in terms of relative displacement between the plates of the micro-loading device to accomplish the complete rupture of the fibrin filaments compared to the other tissues, suggesting that the mucosa might act as a stable interface with the clot and be able to sustain tensile stresses. Conclusions: This in vitro study seems to support the use of mucosa to act as a wall for regenerative procedures of suprabony periodontal defects given its capability to form a stable interface with the clot. Full article

The mechanical behaviour of soils subjected to any stress path in which deviatoric stresses are present is heavily characterised by non-linearity, irreversibility and is strongly dependent on the initial state of stress. The latter, for the majority of geotechnical applications, is normally determined by the at-rest earth pressure coefficient K₀, even though this state is valid, strictly speaking, for axisymmetric conditions and for zero-lateral deformations only. Many expressions are available in the literature for the determination of this coefficient for cohesive and granular materials both for normal consolidated and over-consolidated conditions. These relations are available for low to medium stress levels. Results of an extensive experimental investigation on two sands of different mineralogy up to very high stress (120 MPa) are reported in the paper. For reach very high vertical stresses, a special oedometer has been realised. In the loading phase (normal consolidated sands), the coefficient K_0n depends on the stress level. It passes from values of about 0.8 to values of about 0.45 in the range of effective vertical stress σ′_v = 0.5–4 MPa. Subsequently, K_0n is about constant and varies between 0.45 to 0.55 up to very high vertical effective stresses (120 MPa). For the sands employed in the tests, Jaki’s relation did not lead to reliable results at relatively low pressures, while at high pressures, the same relationship seems to lead to reliable predictions if it refers to the constant volume angle of shear strength. For the over-consolidated sands, K_0C strongly depends on the OCR, and for very high values of OCR, K_0C could be greater than Rankine’s passive coefficient of earth pressure, K_p. This result is due to the very locked structure of the sands caused by the grain crushing, with intergranular contact of sutured and sigmoidal, concavo-convex and inter-penetrating type, that confer to the sand a sort of apparent cohesion and make it similar to weak sandstone. Full article

Objective: Managing flexor tendon injuries surgically remains challenging due to the ongoing debate over the most effective suture technique and materials. An optimal repair must be technically feasible while providing enough strength to allow for early active mobilization during the post-operative phase. This study aimed to assess the biomechanical properties of three modified Kessler repair techniques using two different suture materials: a conventional two-strand and a modified four-strand Kirchmayr–Kessler repair using 3-0 Prolene^® (2s-KK-P and 4s-KK-P respectively), and a four-strand Kessler–Tsuge repair using 4-0 FiberLoop^® (4s-KT-FL). Methods: Human flexor digitorum profundus (FDP) tendons were retrieved from Thiel-embalmed prosections. For each tendon, a full-thickness cross-sectional incision was created, and the ends were reattached using either a 2s-KK-P (n = 30), a 4s-KK-P (n = 30), or a 4s-KT-FL repair (n = 30). The repaired tendons were tested using either a quasi-static (n = 45) or cyclic testing protocol (n = 45). Maximum force (F_max), 2 mm gap force (F_2mm), and primary failure modes were recorded. Results: In both quasi-static and cyclic testing groups, tendons repaired using the 4s-KT-FL approach exhibited higher F_max and F_2mm values compared to the 2s-KK-P or 4s-KK-P repairs. F_max was significantly higher with a 4s-KK-P versus 2s-KK-P repair, but there was no significant difference in F_2mm. Suture pull-out was the main failure mode for the 4s-KT-FL repair, while suture breakage was the primary failure mode in 2s- and 4s-KK-P repairs. Conclusions: FDP tendons repaired using the 4s-KT-FL approach demonstrated superior biomechanical performance compared to 2s- and 4s-KK-P repairs, suggesting that the 4s-KT-FL tendon repair could potentially reduce the risk of gapping or re-rupture during early active mobilization. Full article

Background: Photobiomodulation (PBM) is a non-invasive procedure used to manage pain and inflammation. The aim of this study is to quantitatively measure pain and inflammation and to compare the proposed PBM treatment with a simulated treatment (PBM-SHAM) in patients with dental implants. Materials and Methods: A total of 62 patients were included and randomized into two groups. Group 1 (PBM) consisted of 31 patients subjected to the insertion of dental implants and a single intraoral PBM session with an EPIC X Biolase (0.5 W and 15 J/cm²) diode laser. Group II (PBM-SHAM) included 31 patients subjected to dental implants and a simulated PBM. Each patient was given a document with visual analog scales (VASs) to record pain and inflammation during the 7 days post-surgery. The patients were assessed at the end of the week to remove the sutures, to collect the VASs, and to re-evaluate the surveys. Results: Through the use of mixed effects models, it was found that the length of time after the surgery and the number of implants placed during the intervention were important variables that had an influence on pain and inflammation. Conclusions: PBM is a non-invasive and safe treatment. Postoperative pain and inflammation associated with implant surgery decreased in a similar manner over time, independently of the application of PBM. Therefore, more randomized studies are needed with a standardized methodology to adequately assess the efficacy of this therapy. Full article