Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Remodelado Histológico en Aneurismas Fusiformes en Ratas Wistar tratadas con Wrapping de Algodón y Politetrafluoroetileno / Histological Remodeling in Fusiform Aneurysms in Wistar Rats Treated with Cotton Wrapping and Polytetrafluoroethylene

Intoducción: El tratamiento microquirúrgico para los aneurismas intracraneales es el clipado, sin embargo, algunos aneurismas deben ser resueltos mediante wrapping. El objetivo del trabajo es analizar los cambios histológicos en aneurismas fusiformes en ratas luego del wrapping con algodón natural y politetrafluoroetileno. Materiales y Método: Se trabajó con 12 Ratas Wistar divididas en 3 grupos. Luego de la anestesia se expusieron ambas arterias carótidas comunes, realizándose un aneurisma fusiforme en cada vaso. Se realizó wrapping a las carótidas derechas, grupo 1 con membrana de politetrafluoroetileno, grupo 2 con algodón natural y grupo 3 empleándo combinación de ambos materiales. Los animales fueron sacrificados a los 45 días postoperatorios, para luego procesar las muestras y análisis histológico vascular. Resultados: En el grupo 1 no se evidenciaron modificaciones estructurales, en el grupo 2 se destacó la presencia de células gigantes multinucleadas, inflamación, con infiltrado linfoplasmocitario. En el grupo 3 fue similar al grupo 2 con el agregado de metaplasia condroide y calcificaciones en capa media. Las arterias carotidas izquierdas (control) no presentaron cambios histológicos y a nivel muscular, aumento del tejido conectivo entre las fibras musculares y fibroblastos en el grupo 2. Discusión: Existen publicaciones sobre la técnica de wrapping con materiales autólogos o heterólogos. Sin embargo, no existen análisis experimentales de los efectos microestructurales producidos en las arterias tras la creación y tratamiento de un aneurisma fusiforme. Conclusiones: La combinación más efectiva para reforzar la pared del aneurisma y evitar la reacción inflamatoria circundante es la utilización de algodón natural y politetrafluoroetileno

Intoduction: The microsurgical treatment for intracranial aneurysms is clipping, however, some aneurysms must be resolved by wrapping. The objective of the work is to analyze the histological changes in fusiforms aneurysms in rats after wrapping with natural cotton and polytetrafluoroethylene. Materials and Method: We worked with 12 Wistar rats divided into 3 groups. After anesthesia, both common carotid arteries were exposed, making a fusiform aneurysm in each vessel. Right carotid wrapping was performed, group 1 with a polytetrafluoroethylene membrane, group 2 with natural cotton, and group 3 using a combination of both materials. The animals were sacrificed 45 days after surgery, to process the specimens and vascular histological analysis. Results: In group 1 there were no structural modifications, in group 2 the presence of multinucleated giant cells, inflammation, with lymphoplasmacytic infiltrate stood out. In group 3 it was similar to group 2 with the addition of chondroid metaplasia and calcifications in the middle layer. The left carotid arteries (control) did not present histological changes and at the muscle level, increased connective tissue between muscle fibers and fibroblasts in group 2. Discussion: There are publications on the wrapping technique with autologous or heterologous materials. However, there are no experimental analyzes of the microstructural effects produced in the arteries after the creation and treatment of a fusiform aneurysm. Conclusions: The most effective combination to reinforce the wall of the aneurysm and avoid the surrounding inflammatory reaction is the use of natural cotton and polytetrafluoroethylene

Sleeve Shaping Technique for Two Cases of Peripheral Artery Aneurysms Involving Important Branches / 中国医学科学院学报

Peripheral artery aneurysms,with low incidence and complex anatomic structure,often involve important branches.This paper introduces a new surgical technique-sleeve shaping on the basis of two cases.The basic data,including characteristics,imaging,operation and follow-up data of the cases,were collected.The data were then combined with the previous literature for explaining in detail that this technique can be used as a supplementary method of reconstruction following resection or endovascular repair.

Pro-vascularization of tubular graft of bone marrow mesenchymal stem cells and bladder acellular matrix wrapped up in omentum / 西安交通大学学报(医学版)

Objective: To study the vascularization of tubular graft of bone marrow mesenchymal stem cells (BMSCs) and bladder acellular matrix (BAM) wrapped up in omentum. Methods: We planted BMSCs on the BAM and made it into tubular grafts. Thirty healthy New Zealand white rabbits were randomly divided into three groups with 10 rabbits in each. Rabbits in experimental group received BMSCs-BAM tubular graft wrapped in omentum. Rabbits in control group received BAM tubular graft wrapped in omentum. Rabbits in blank group were planted with silicone catheter wrapped in omentum. Vascular endothelial growth factor (VEGF) protein, CD34 expression and microvessel density of the graft were measured at weeks 4 and 8, respectively. Results: ① The expression of VEGF protein was higher in the experimental group than in the control group and the blank group, and the expression of VEGF protein was higher in the control group than in the blank group; the differences among the three groups were statistically significant [F(2,15)=5.314, P=0.017]. ② The microvessels with positive CD34 expression were denser in the experimental group than in the other two groups, and the blood vessels were closely connected with each other. The microvessels with positive CD34 expression were also much denser in the control group than in the blank group. ③ The microvessel density was higher in the experimental group than in the control group and the blank group, and it was also higher in the control group than in the blank group. The differences among the three groups were statistically significant [F(2,12)=6.172, P=0.021]. Results: Omental wrapping promotes vascularization of BAM, and planting BMSCs on the BAM is more conducive to vascularization of BAM.

Successful Surgical Treatment for Pharyngeal Perforation in a Patient with Aortic Valve Infectious Endocarditis / 日本心臓血管外科学会雑誌

Pharyngeal perforation is a rare but crucial complication of transesophageal echocardiography during cardiac surgery. We herein report the case of a 72-year-old man with infective endocarditis in the aortic valve, who had a poor performance status due to congestive heart failure and brain infarction. The echo probe of the transesophageal echocardiography was detected in the anterior mediastinum after median sternotomy. Pharyngeal repair after aortic valve replacement with bioprosthetic valve, following omental wrapping was performed simultaneously. The operative course was relatively good, and the patient moved to the general ward 32 days after the surgery.

Treatment of Exposed Hydroxyapatite Orbital Implants Wrapped with a Synthetic Dura Substitute

PURPOSE: To describe cases of exposed hydroxyapatite (HA) implants wrapped with the synthetic dura substitute Neuro-Patch treated via simple Neuro-Patch removal. METHODS: The medical records of seven patients who experienced exposure of their HA implant were reviewed. All patients had been enucleated and implanted with HA wrapped with Neuro-Patch. For treatment, Neuro-Patch was removed to the greatest extent possible. After applying local anesthesia with lidocaine, blunt dissection was performed to separate the conjunctiva and Neuro-Patch via the site of exposure. Pressure was applied to the remaining Neuro-Patch with forceps and removed with scissors. RESULTS: Neuro-Patch was visible at the area of exposure in all patients. No surgery beyond initial Neuro-Patch removal was necessary in six of the seven patients. In five cases, the exposed area began to heal rapidly after Neuro-patch removal without primary closure of the defect. In one case, the Neuro-Patch material and all necrotic tissue was removed aggressively due to inflammation around the orbital implant. Lastly, an infection was noted in one case, prompting complete removal of the Neuro-Patch–wrapped HA implant. CONCLUSIONS: Wrapping material may hinder implant vascularization. Exposure of HA in wrapped implants can be successfully treated by a simple removal procedure if detected and managed early.

Cancellous bone wrapping grafting for segmental defects of long bone / 中华创伤骨科杂志

Objective To investigate the principles and effects of cancellous bone wrapping grafting for treatment of segmental defects of long bone.Methods From January 2008 to December 2015,50 patients with segmental long bone defect were treated by various wrapping grafting with rich autogenous cancellous bone.They were 31 males and 19 females,aged from 13 to 69 years (average,34.6 years).The cancellous bone was wrapped by titanium mesh in 8 cases,by wire mesh in 10,by line binding in 13,and by induced membrane in 19.The bone defect was located at tibia in 22 cases,at radius in 10,at humerus in 8,at ulna in 7 and at femur in 3.The length of bone defect ranged from 3 to 9 cm,averaging 5.9 em.Bone healing,complications and functionary recovery of adjacent joint were recorded.The bone defect healing and functionary recovery of adjacent joint were evaluated according to the Paley criteria.Results The incisions healed by the first intention in 48 cases and by the second in 2.All were followed up for 12 to 48 months (average,19.1 months).All the bone defects healed by the first intention but one treated by induced membrane wrapping which was healed 15 months later by the secondary grafting due to nonunion at ends.The total clinical healing time ranged from 3 to 16 months (average,6.1 months).The last follow-ups showed that all the affected limbs resumed weight-bearing activities.The healing of bone defects was graded as excellent in all but one in the group of induced membrane wrapping.Totally,the functionary recovery of adjacent joint was excellent in 18,good in 22,fair in 7 and poor in 3 cases (an excellent and good rate of 80.0％).Conclusions Cancellous bone wrapping grafting can avoid or significantly reduce loosening and absorption of cancellous bone graft after traditional bone grafting.Although it is effective for treatment of large segmental bone defect,its methods should vary according to the specific conditions of the patient.

Clinical application of ballon-assisted surgical wrapping-clipping for blood blister-like aneurysms of internal carotid artery / 中国医师进修杂志

Objective To investigate the effectiveness and safety of ballon-assisted surgical wrapping-clipping for the treatment of blood blister-like aneurysms (BBA) of internal carotid artery. Methods The clinical data of 9 patients with BBA of internal carotid artery who were treated by ballon-assisted surgical wrapping-clipping from August 2011 to June 2016 were retrospectively analyzed. Results All 9 patients were successfully treated with surgical wrapping-clipping in ballon-assisted technique. The BBA had no rebleeding.Nine cases were followed up clinically for six months. Digital subtractive angiography demonstrated no aneurysm in these patients, and showed no stenosis in the parent artery. Conclusions Ballon-assisted surgical wrapping-clipping in the treatment of BBA is effective and safety. It may help to reduce the risks of BBA rebleeding and recurrence.

Cancellous bone wrapping grafting for segmental defects of long bone / 中华创伤骨科杂志

Objective To investigate the principles and effects of cancellous bone wrapping grafting for treatment of segmental defects of long bone.Methods From January 2008 to December 2015,50 patients with segmental long bone defect were treated by various wrapping grafting with rich autogenous cancellous bone.They were 31 males and 19 females,aged from 13 to 69 years (average,34.6 years).The cancellous bone was wrapped by titanium mesh in 8 cases,by wire mesh in 10,by line binding in 13,and by induced membrane in 19.The bone defect was located at tibia in 22 cases,at radius in 10,at humerus in 8,at ulna in 7 and at femur in 3.The length of bone defect ranged from 3 to 9 cm,averaging 5.9 em.Bone healing,complications and functionary recovery of adjacent joint were recorded.The bone defect healing and functionary recovery of adjacent joint were evaluated according to the Paley criteria.Results The incisions healed by the first intention in 48 cases and by the second in 2.All were followed up for 12 to 48 months (average,19.1 months).All the bone defects healed by the first intention but one treated by induced membrane wrapping which was healed 15 months later by the secondary grafting due to nonunion at ends.The total clinical healing time ranged from 3 to 16 months (average,6.1 months).The last follow-ups showed that all the affected limbs resumed weight-bearing activities.The healing of bone defects was graded as excellent in all but one in the group of induced membrane wrapping.Totally,the functionary recovery of adjacent joint was excellent in 18,good in 22,fair in 7 and poor in 3 cases (an excellent and good rate of 80.0％).Conclusions Cancellous bone wrapping grafting can avoid or significantly reduce loosening and absorption of cancellous bone graft after traditional bone grafting.Although it is effective for treatment of large segmental bone defect,its methods should vary according to the specific conditions of the patient.

Combination Treatment for Rapid Growth of a Saccular Aneurysm on the Internal Carotid Artery Dorsal Wall: Case Report

Aneurysms arising from non-branching sites of the supraclinoid internal carotid artery (ICA) are considered rare, accounting for only 0.9-6.5% of all ICA aneurysms. They are thin-walled, broad-based, can easily rupture during surgery, and are referred to as dorsal, superior, anterior, or ventral wall ICA aneurysms, as well as blister-like aneurysms. Various treatment modalities are available for blister-like aneurysms, but with varying success. Here, we report on two cases of saccular shaped dorsal wall aneurysms. Both patients were transferred to the emergency department with subarachnoid hemorrhage because of an aneurysmal rupture. Computed tomography angiography and transfemoral cerebral angiography (TFCA) showed a dorsal wall aneurysm in the distal ICA. We performed clipping on the wrapping material (Lyodura(R), temporal fascia). Follow-up TFCA showed rapid configuration changes of the right distal ICA. Coil embolization was also performed as a booster treatment to prevent aneurysm regrowth. Both patients were discharged without neurologic deficit. No evidence of aneurysm regrowth was observed on follow-up TFCA at two years. Dorsal wall ICA aneurysms can change in size over a short period; therefore, follow-up angiography should be performed within the short-term. In cases of regrowth, coil embolization should be considered as a booster treatment.

Septin 7: Actin cross-organization is required for axonal association of Schwann cells

Myelin sheaths present two distinct domains: compacted myelin spirals and flanking non-compacted cytoplasmic channels, where lipid and protein segregation is established by unknown mechanisms. Septins, a conserved family of membrane and cytoskeletal interacting GTPases, form intracellular diffusion barriers during cell division and neurite extension and are expressed in myelinating cells. Septins, particularly septin 7 (Sept7), the central constituent of septin polymers, are associated with the cytoplasmic channels of myelinating cells. Here we show that Schwann cells deprived of Sept7 fail to wrap around axons from dorsal root ganglion neurons and exhibit disorganization of the actin cytoskeleton. Likewise, Sept7 distribution is dependent on microfilament but not microtubule organization.

Wrapping of the lower limbs for prevention of post spinal hypotension during cesarean section under spinal anesthesia

BACKGROUND: Hypotension is the most frequent complication associated with spinal anesthesia during cesarean section. Prehydration and/or vasopressor therapy is commonly used for prevention of hypotension in cesarean deliveries. Wrapping of the legs is simple to perform before surgery and was reported be effective for the prevention of post spinal hypotension in a few obstetric units. So we investigated whether wrapping of the legs prevents post spinal hypotension during cesarean section. METHODS: 45 patients were randomly allocated to one of 3 groups (15 in each group): prehydration with 10 ml/kg (group I), prehydration with 10 ml/kg and wrapping of the legs (group II), prehydration with 5 ml/kg and wrapping of the legs (group III). Hypotension was defined as a 20% decrease from initial systolic arterial pressure (SAP) or SAP lower than 90 mmHg and was treated with intravenous ephedrine (4 mg, repeated). Blood pressure was recorded before spinal anesthesia and every min for 10 min and then every 2 min for another 10 min after spinal anesthesia. RESULTS: Group I showed a significant decrease in SAP compared to group II and group III 1 min after spinal anesthesia, but after that, there was no significant difference between the three groups. Group II showed a significant difference in incidence of severe hypotension after spinal anesthesia compared with group I, but there was no difference of the incidence of hypotension between the three groups. CONCLUSIONS: Wrapping of the legs for prevention of post spinal hypotension during elective cesarean section reduces the severity of hypotension.

The clip-wrap technique in the treatment of intracranial unclippable aneurysms / Técnica de "clip-wrap" no tratamento de aneurismas rotos não clipáveis

Fusiform and dolichoectatic aneurysms are challenging lesions to treat with direct clipping. Treatment of these aneurysms often requires alternative surgical strategies, including extracranial-intracranial bypass, wrapping, or clip-wrap techniques. Nonetheless, these alternatives methods of treatment have been underused and frequently overlooked. Objective: To report a series of nine cases of otherwise untreatable aneurysms managed using the clip-wrap technique and discuss its surgical nuances. Method: In the last four years, 9 cases of ruptured aneurysms treated by the clip-wrap techniques were identified in the Division of Neurological Surgery, University of São Paulo, School of Medicine. Results: The aneurysms were located at middle cerebral artery (2), anterior choroidal artery (1), anterior communicating artery (1), carotid ophthalmic (3), posterior cerebral artery (1) and posterior-inferior cerebellar artery (1). Three were dolichoectatic, 4 were unsuitable to complete surgical clipping because parent or efferent vessels arises from the aneurysm sac (1 MCA, 1 AcomA, 1 CO, 1 PICA aneurysms) and two, although ruptured aneurysms, were too small (<2mm) to be directly clipped. No early or late rebleeding was observed after 2 years mean follow-up. One patient deceased due to pulmonary tromboembolism. Conclusion: Clip-wrap techniques for the treatment of fusiform and otherwise unclippable aneurysms seem to be safe and it can be associated with a low rate of acute or delayed postoperative complications. It can prevent rebleeding and represents an improvement when compared with the natural history.

Aneurismas fusiformes são lesões de difícil tratamento e frequentemente necessitam de técnicas alternativas de tratamento, incluindo anastomose extra-intracranial ou técnicas de "clip-wrap". Contudo o uso destas técnicas é frequentemente esquecido e negligenciado. Objetivo: Descrever retrospectivamente casuística de nove casos de aneurismas não clipáveis tratados com a técnicas de "clip-wrap" e discutir as nuances cirúrgicas. Resultados: Revisão dos últimos quatro anos da casuística da Divisão de Clínica Neurocirúrgica do HCFMUSP mostrou que 384 casos eram de aneurismas rotos. Destes, 9 eram de aneurismas não clipáveis tratados com a técnica de "clip-wrap". Destes, 2 aneurismas eram de artéria cerebral media, 1 de artéria coroidéia anterior, 1 de artéria comunicante anterior, 3 de artéria oftálmica, 1 de artéria cerebral posterior e 1 de PICA. Três eram lesões ectásicas, 4 não puderam ser completamente clipados devido a relação de aneurismas com vasos eferentes, aferentes ou perfurantes, e dois, apesar de rotos eram pequenos demais para serem clipados (<2,0 mm). Sangramento precoce ou tardio não foram observados, em um seguimento médio de 2 anos. Conclusão: A técnica descrita é segura e está associada com baixa incidência de complicações agudas ou tardias. Ela previne ressangramanto e representa um avanço em relação à história natural destas lesões.

New Operative Treatment of Hyperfunctioning Arteriovenous Fistula for Hemodialysis: A Case Report

Hyperfunctioning fistulas are rare complications of hemodialysis access. They give rise to devastating complications, including a steal syndrome with reduced perfusion to the dependent limb and cardiac insufficiency caused by the high shunt volume. Numerous techniques such as fistula ligation, banding, plication, T-banding and distal revascularization with interval ligation have been developed. However, each technique bears the potential for its own complications, such as failure to resolve symptoms, recurrence and technical difficulty. Herein, we report a new technique that remedies the shortcomings of the other procedures. All the patients first underwent partial aneurysmal resection and lateral aneurysmorrhaphy of the enlarged vein from just distal to the anastomosis using a 6-0 prolene running sutures and then external wrapping with an 8 mm expanded polytetrafluoroethylene graft was done for a length of approximately 5 cm. Two patients with hyperfunctioning brachiocephalic arteriovenous fistula were treated this way. Doppler measurement of the fistula flow showed a mean flow reduction of about 60%. The procedure was effective and safe, with a mean follow up of 2 months.

The Treatment of Neuroma-in-Continuity with Interpositional Nerve Graft and Vein Wrapping: A Case Report

We report a case of 44 years old male patient with neuroma-in-continuity of ulna nerve. In the patient's past history, he had received operative treatment for the open supracondylar fracture of right distal humerus and ulnar nerve injury at 10 years ago, and neurolysis was tried 2 times due to severe neuropathic pain. Despite of these operations, the symptom was not improved. In operative field, we noticed neuroma-in-continuity and decided to resect the neuroma until normal nerve fascicle was noted. The nerve cable graft was done with auto sural nerve on the defect site and the nerve was wrapped with small saphenous vein. At post operative 7 months, pain was markedly decreased and sensory recovery was slightly improved and patient was satisfied with the result.

Sterilization of Small Packs of Surgical Instruments:A Cost Performance Study / 中华医院感染学杂志

OBJECTIVE To analyze the cost performance of small packs of surgical instruments and to look for their optimizing sterilization schemes.METHODS 720 sample from total surgical instruments were sefested,pressuresteam sterilization ethylene Oxide and hydrogen peroxide plasma sferilization were pexformal and compared.Statistics and analyzing finally under the condition of each kind puts The sterilization effect,cost and the period were analyzed.RESULTS All three methods call guarantee the sterilization effect,but the cost of EO and plasma were more than those of pressuresteam method(452% and 960%).CONCLUSIONS Pressuresteam sterilization show advantages in small packing instruments.

Evaluation of Surgery for Aneurysms that arise from a Non-Branching Site of the Intracranial Internal Carotid Artery (ICA) / 대한뇌혈관외과학회지

OBJECT: Surgery for aneurysms at non-branching sites of an internal carotid artery (ICA) is considered based on the size, shape, direction and site of the aneurysm. In this study, we analyzed characteristics of aneurysms that have arisen from non-branching sites of an ICA from the viewpoint of surgery. METHODS: From 2003 to 2007, 346 intracranial aneurysms were treated at our institute. 19 (5.5%) aneurysms were non-branching site aneurysms of an ICA. Surgery for these aneurysms was retrospectively analyzed in view of the treatment strategy according to the site, size, and configuration of the aneurysms in videos obtained during surgery. RESULTS: There were 13 cases of a ruptured aneurysm (68.4%) and six cases of an unruptured aneurysm (31.6%). There were ten cases of a saccular type of aneurysm (52.6%) and nine cases of a blood blister-like aneurysm (47.4%). There were seven aneurysms that arose from the dorsal wall of an ICA (36.8%), six aneurysms that arose from the ventral wall (31.6%), four aneurysms that arose from the lateral wall (21.1%) two aneurysms that arose from the medial wall (10.5%). Three patients with unruptured blood blister-like aneurysms underwent simple wrapping and wrapping with the use of clip. Three unruptured saccular aneurysms could be clipped perpendicular to an ICA or at a slant to an ICA. Three out of six (50%) ruptured blood blister-like aneurysms were ruptured during surgery. These aneurysms were clipped with the partial wall of an ICA, resulting in ICA stenosis. We treated 15 (84%) of 19 cases by only clipping, one case (5.2%) was treated by clipping with bypass surgery and three cases (15%) were treated by wrapping. CONCLUSION: Ruptured aneurysms of nonbranching sites of an ICA such as blister-like or dorsal saccular aneurysms have a high risk of rupture and can be difficult to clip. If clipping of the aneurysms is possible, preoperative balloon test occlusion should be performed to avoid ICA stenosis after clipping of the aneurysm neck with the arterial wall. Clipping after bypass or trapping can vary the treatment strategy and improve patient outcome. For small-unruptured aneurysms from nonbranching sties of an ICA, wrapping with the use of clip may be a useful method for treatment regardless of the clipping direction.

Wrapping of Porous Orbital Implant Using Acellular Dermal Allograft

PURPOSE: To investigate the results when using the acellular dermal allograft (SureDerm(R), Hans Biomed Co., Korea) as a new wrapping material for porous orbital implants. METHODS: The charts of 11 patients who underwent either primary or secondary insertion of Medpor(R) orbital implants after enucleation or a new insertion after removal of previous orbital implants were reviewed. Medpor(R) orbital implants either 18 or 20 mm were wrapped with SureDerm(R) in 4x4 cm sections that were 1-mm-thick. Four rectus muscles were fixed to the SureDerm(R) wrapped implant, and a conjunctival suture was made with 6-0 Vicryl. All patients had follow-up periods longer than 10 months and were evaluated to determine the success of wrapping and to identify any complications. RESULTS: The average age of the patients was 48.3 years. The patients wore artificial eyes for 9 weeks after the operation, and the follow-up periods were 22.4 months on average. There was no case of implant or SureDerm(R) exposure, inflammation, and other significant complications except in one case that required fornix reconstruction to allow the subject to wear an artificial eye. CONCLUSIONS: Acellular dermal allograft appears to be a good substitute material if preserved sclera is not available when inserting orbital implants with wrapping.

Clinical and Angiographic Results after Treatment with Combined Clipping and Wrapping Technique for Intracranial Aneurysm

OBJECTIVE: There have been numerous follow-up studies of patients who had ruptured or unruptured intracranial aneurysms treated by wrapping technique using various materials have been reported. Our objective was to ascertain whether our particular wrapping technique using the temporalis muscle provides protection from rebleeding and any aneurysm configuration changes in follow-up studies. METHODS: Clinical presentation, the location and shape of the aneurysm, outcomes at discharge and last follow-up, and any aneurysm configuration changes on last angiographic study were analyzed retrospectively in 21 patients. Reinforcement was acquired by clipping the wrapped temporalis muscle. Wrapping and clipping after incomplete clipping was also done. Follow-up loss and non-angiographic follow-up patient groups were excluded in this study. RESULTS: The mean age was 53 years (range 29-67), and 15 patients were female. Among 21 patients, 10 patients had ruptured aneurysms (48%). Aneurysms in 21 patients were located in the anterior circulation. Aneurysm shapes were broad neck form (14 cases), fusiform (1 case), and bleb to adjacent vessel (6 cases). Five patients were treated by clipping the wrapped temporalis, and 16 patients by wrapping after partial clipping. The mean Glasgow coma scale (GCS) at admission was 14.2. The mean Glasgow outcome scale (GOS) at discharge was 4.8, and 18 patients were grade 5. The mean period between initial angiography and last angiography was 18.5 months (range 8-44). Aneurysm size was not increased in any of these patients and configuration also did not change. There was no evidence of rebleeding in any of these treated aneurysms. CONCLUSION: Our study results show that wrapping technique, using the temporalis muscle and aneurysm clip(s), for intracranial aneurysm treatment provides protection from rebleeding or regrowth.

Expanded Polytetrafluoroethylene as a Wrapping Material for Porous Polyethylene Orbital Implant

PURPOSE: To investigate the possibility of expanded polytetrafluoroethylene (e-PTFE) as a wrapping material for porous polyethylene orbital implant. METHODS: Two groups of 6 female New Zealand albino rabbits underwent enucleation with placement of a 12 mm porous polyethylene orbital implant wrapped in simple e-PTFE in one group (group 1) and macro-porous e-PTFE in the other group (group 2). Histopathologic sections of the implants obtained at 4, 6, 8 weeks were compared on the extent of fibrovascular ingrowth, percentage of the area of proliferated vessel, and grade of fibrosis between the two groups. RESULTS: There was no implant exposure or severe inflammation in group 1 and 2 during the observation. The extent of fibrovascular ingrowth differs only at 4 weeks. Group 1 showed less fibrovascular ingrowth (until outer 1/3) at anterior half compared with posterior one, but there was no difference between anterior and posterior half in group 2 (until middle 1/3). The percentage of the area of the proliferated vessels was higher in group 2 than group 1 at both anterior and posterior half, and the anterior/posterior ratio of the area of vessels was also higher in group 2 than group 1. The grade of fibrosis was higher in group 2 than group 1 at 4, 6, and 8 weeks. CONCLUSIONS: Macro-porous e-PTFE almost didn't disturb fibrovascular ingrowth into the orbital implant, so macro-porous e-PTFE can be used safely as a wrapping material for porous polyethylene orbital implant.