Ushering in the era of regenerative surgery.

Tissue loss, irrespective of etiology, often requires extensive reconstruction. In many instances, the need exceeds what current treatments and technologies modern medicine can offer. Tissue engineering has made immense strides within the past few decades due to advances in biologics, biomaterials, and manufacturing. The convergence of these three domains has created limitless potential for future surgical care. Unfortunately, there still exists a disconnect on how to best implant these 'replacement parts' and care for the patient. It is therefore vital to develop paradigms for the integration of advanced surgical and tissue engineering technologies. This paper explores the convergence between tissue engineering and reconstructive surgery. We will describe the clinical problem of tissue loss, discuss currently available solutions, address limitations, and propose processes for integrating surgery and tissue engineering, thereby ushering in the era of regenerative surgery.

Vascular persistence following precision micropuncture.

OBJECTIVE: The success of engineered tissues continues to be limited by time to vascularization and perfusion. Recently, we described a simple microsurgical approach, termed micropuncture (MP), which could be used to rapidly vascularize an adjacently placed scaffold from the recipient macrovasculature. Here we studied the long-term persistence of the MP-induced microvasculature. METHODS: Segmental 60 µm diameter MPs were created in the recipient rat femoral artery and vein followed by coverage with a simple Type 1 collagen scaffold. The recipient vasculature and scaffold were then wrapped en bloc with a silicone sheet to isolate intrinsic vascularization. Scaffolds were harvested at 28 days post-implantation for detailed analysis, including using a novel artificial intelligence (AI) approach. RESULTS: MP scaffolds demonstrated a sustained increase of vascular density compared to internal non-MP control scaffolds (p < 0.05) secondary to increases in both vessel diameters (p < 0.05) and branch counts (p < 0.05). MP scaffolds also demonstrated statistically significant increases in red blood cell (RBC) perfused lumens. CONCLUSIONS: This study further highlights that the intrinsic MP-induced vasculature continues to persist long-term. Its combination of rapid and stable angiogenesis represents a novel surgical platform for engineered scaffold and graft perfusion.

Using a Bougie With C-MAC Video Laryngoscopy Did Not Improve First-Attempt Intubation Success Rates in Critical Care Air Transport.

OBJECTIVE: Studies have shown a bougie improves first-attempt success rates when used in combination with direct laryngoscopy during the initial attempt. The purpose of this study was to determine whether the use of a bougie in combination with C-MAC (Karl Storz, Tuttlingen, Germany) improves first-attempt success rates of endotracheal intubation (ETI) compared with C-MAC with a traditional stylet. METHODS: This study is a retrospective chart review using data collected on 371 intubations completed by a single air medical service using the C-MAC laryngoscope and either a bougie or a stylet. RESULTS: The overall success rate using C-MAC for ETI with either a bougie or a stylet was 83%. There was no statistically significant difference between first-attempt successful intubations using C-MAC and a bougie (82%) or a stylet (86%) (χ1 = 0.871, P = .351). There was no statistically significant difference between laryngoscopy grade and the number of attempts that resulted in a successful intubation (χ1 = 0.743, P = .7). CONCLUSION: There was no difference between first-attempt success rates using video laryngoscopy with a bougie, overall intubation success rates, or difficult intubation success rates compared with video laryngoscopy with a stylet, indicating that the purpose of a bougie as a rescue device did not hold true in the prehospital setting of our critical care air medical service.

Quantifying the Impact of Comorbidities on Length of Stay in Geriatric Fall-Related Injuries.

Geriatric patients who fall are among the most common mechanisms of injury presenting to trauma centers. We sought to quantify the impact of various comorbidities on length of stay (LOS) in these patients to identify areas for intervention. A level 1 trauma center's registry was queried for patients ≥65 years old with fall related injuries admitted with LOS greater than 2 days. Over 7 years, 3714 patients were included. Mean age was 80.9 ± 8.7 years. All patients fell from heights of 6 feet or less. Median total LOS was 5 days, interquartile range [3,8]. Overall mortality rate was 3.3%. The most common comorbidities were cardiovascular (57.1%), musculoskeletal (31.4%), and diabetes (20.8%). Multivariate linear regression modeling LOS identified diabetes, pulmonary, and psychiatric diseases associated with longer lengths of stay (P < .05). As trauma centers refine care for geriatric trauma patients, comorbidity management represents an opportunity for proactive intervention.