Alleviation of peripheral sensitization by quadriceps insertion of cog polydioxanone filaments in knee osteoarthritis rats.

A recently established therapeutic strategy, involving the insertion of biodegradable cog polydioxanone filaments into the quadriceps muscles using the Muscle Enhancement and Support Therapy (MEST) device, has demonstrated significant efficacy in alleviating knee osteoarthritis (OA) pain. This study investigated changes in peripheral sensitization as the potential mechanism underlying MEST-induced pain relief in monoiodoacetate (MIA) induced OA rats. The results revealed that MEST treatment potently reduces MIA-induced sensitization of L3/L4 dorsal root ganglion (DRG) neurons, the primary nociceptor pathway for the knee joint. This reduction in DRG sensitization, as elucidated by voltage-sensitive dye imaging, is accompanied by a diminished overexpression of TRPA1 and NaV1.7, key nociceptor receptors involved in mechanical pain perception. Importantly, these observed alterations strongly correlate with a decrease in mechanically-evoked pain behaviors, providing compelling neurophysiological evidence that MEST treatment alleviates OA pain by suppressing peripheral sensitization.

Effect of poly-L-lactic acid and polydioxanone biostimulators on type I and III collagen biosynthesis.

OBJECTIVE: Safe, effective, and biocompatible minimally invasive procedures with the potential to stimulate collagen production have been made to recover dermal thickness and skin quality. The main of this animal model experiment was to observe the effect of poly-L-lactic acid (PLLA) and polydioxanone (PDO) biostimulators in collagen I and III after hypodermal injection. METHODOLOGY: Sixteen adult female rats (Wistar) were randomized into four groups and had dorsal treatment with: G1: hypodermic subcision (HS) only; G2: HS and PLLA hypodermic injection (HI), G3: HS and PDO HI; G4: Control, with no treatment. RESULTS: In histochemical, it was observed hypodermal and dermal tissue in more organized thickness in G3 and in G4 when compared to G1 and G2. There was few difference in G1 compared to G4. The tissue of G2 showed irregularities in the arrangement of collagen fibers, less defined structure and lower distribution of type I collagen compared to the other groups. There is a greater tendency for the proportions of type III collagen among tissues treated with both biostimulators (G2 and G3). PLLA and PDO had relatively similar percentages of collagen when compared to G4. The amount of type I collagen was higher in tissues treated with subcision, while type III collagen was higher in tissues treated with both biostimulators. CONCLUSION: G3 showed better performance in collagen production, although small, when compared with G2.

Horizontal necklines correction with absorbable braided polydioxanone threads: Case series.

INTRODUCTION: The prevalence of horizontal neck lines as a cosmetic concern is widely acknowledged, yet the available treatment options are limited, and no studies have investigated the use of polydioxanone-barbed threads. These threads, characterized by a finely braided structure, function as a scaffold to attract regenerative factors and facilitate the migration and proliferation of cells. This study aims to evaluate the outcomes of concurrent application of braided polydioxanone-barbed threads for addressing horizontal neck wrinkles. METHODOLOGY: A retrospective case series involving four female participants (aged 41, 43, 45, and 46) treated with polydioxanone-barbed threads for horizontal neck wrinkles between January 2023 and July 2023 was conducted. Adult patients were assessed at an 8-week follow-up, revealing a significant reduction in wrinkle intensity based on the Horizontal Neck Wrinkle Severity Scale. RESULTS: The analysis of horizontal neck lines demonstrated a notable decrease in wrinkle intensity according to the Horizontal Neck Wrinkle Severity Scale at the 8-week mark, and this improvement maintained statistical significance. Both patient Global Aesthetic Improvement Scale (GAIS) scores (90%-100%) and physician GAIS scores (100%) were rated as excellent. CONCLUSION: The subdermal application of polydioxanone-barbed threads for horizontal neck lines proves to be a secure and efficacious approach for treating horizontal neck wrinkles, with no observed Tyndall effect. This technique shows promise for rejuvenating the skin in the horizontal neckline region.

Evaluation of Physical Properties of Coated Polydioxanone Threads.

BACKGROUND: Using a thread for wound closure promotes healing and minimizes contamination by foreign substances. Threads have also been employed in esthetic surgery; however, functional threads that can improve wrinkles and rejuvenate the skin are required. OBJECTIVE: To evaluate the suitability of polydioxanone threads coated with polyethylene glycol, hyaluronic acid, and amino acids for use in the medical field because such formulations are expected to promote regeneration and collagen synthesis. MATERIALS AND METHODS: Physical properties (diameter [ n = 20], tensile strength [ n = 20], strength retention rate [ n = 10], and scanning electron microscopy images) and cytotoxicity (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide and lactate dehydrogenase assays) of polydioxanone threads coated with polyethylene glycol, hyaluronic acid, and amino acids were assessed and compared with those of uncoated polydioxanone threads. Analyses were performed using IBM SPSS Statistics (Statistical significance; p values <.05). RESULTS: The size standards for tensile strength (≥63.5 N) and diameter (average 0.570-0.610 mm) were met. There were no differences in the physical properties of the coated and uncoated threads; however, the biocompatibility of coated threads was high owing to low cytotoxicity. CONCLUSION: Threads coated with materials that can promote regeneration are suitable for use in the medical field.

Biodegradable tracheal stents: our ten-year experience with adult patients.

BACKGROUND: Biodegradable (BD) stents made from polydioxanone have been used only in human airways. These stents combine the advantages of classical tracheal stents, and fewer side effects are expected due to their biocompatibility and their time-limited presence in airways. However, new clinical consequences have arisen. Here, the authors share their experiences with BD stents for tracheal indications, focusing on their safety and efficacy. METHODS: This was a retrospective review of a collected database of adult patients who underwent implantation of biodegradable tracheal stents between September 2013 and December 2022 at the Department of Respiratory Medicine of the 1st Faculty of Medicine in Prague and Thomayer University Hospital. The indications included functionally significant nonmalignant tracheal stenosis and tracheomalacia. Self-expandable, biodegradable, polydioxanone tracheal stents manufactured by ELLA-CS Ltd. (Hradec Kralove, Czech Republic) were implanted during rigid bronchoscopy under general anaesthesia. All patients were followed up in the department and were provided with the necessary care. The main efficacy and safety parameters and relationships were analysed using descriptive statistics and Fisher´s exact, Wilcoxon and Kruskal‒Wallis tests. RESULTS: A total of 65 stents were implanted in 47 adult patients. During the first two months after implantation, when adequate function was expected, the stent was found to be effective in 26 out of 39 patients who completed this period (66.7%). The clinical effectiveness reached 89.7%, as early restenoses were mostly mild and necessitated treatment in only 4 patients. The frequencies of significant mucostasis, migration and granulation tissue growth were 2.6%, 7.5% and 23.1%, respectively, during this period. Thirty-four participants completed the half-year follow-up period after the first or second stent insertion, and some were followed up beyond this period. Poor control of symptoms, the development of restenosis and the need for interventions were characteristic of this period as the stents degraded. Twenty-two patients who experienced remodelling or stabilization of the tracheal lumen achieved a stent-free state. Seven patients underwent subsequent surgical treatment. CONCLUSIONS: BD stents are safe and provide adequate tracheal support until they begin to degrade. The use of BD stents necessitates close monitoring of patients and accurate treatment of possible restenosis. TRIAL REGISTRATION: Based on project NT14146 - Biodegradable stents in the management of the large airways (2013-2015, MZ0/NT), registered on May 1, 2013, in the Research and Development and Innovation Information System of the Czech Republic and at ClinicalTrials.gov (reg. no. NCT02620319, December 2, 2015).

Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis.

PURPOSE: To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS: We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS: Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS: AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.

Comparative In Vivo Study of Solid-Type Pure Hyaluronic Acid in Thread Form: Safety and Efficacy Compared to Hyaluronic Acid Filler and Polydioxanone Threads.

INTRODUCTION: Although various products are commonly used for skin rejuvenation, solid-type hyaluronic acid (HA) as an injectable form has not been researched or utilized. This study aimed to demonstrate the safety and efficacy of solid-type HA in thread form, which differs from the conventional gel-type HA commonly used. METHOD: Solid-type HA threads, conventional HA fillers, and polydioxanone (PDO) threads were inserted into the dorsal subcutaneous layer of mice. Photographs were taken on days 0, 1, 3, and 7, and on day 7, the samples were harvested for histological analysis. Inflammatory reactions and detection of collagen were confirmed through tissue staining, and real-time PCR was conducted to quantify collagen synthesis. RESULTS: In the histological analysis, the PDO threads exhibited a greater inflammatory response compared to the HA threads. Masson's trichrome staining revealed a higher degree of collagen synthesis in the HA thread group compared to the HA filler group. While collagen type 1 expression was significantly higher in the PDO thread group than in the HA thread group, the HA thread group showed higher expression levels of collagen type 3. Furthermore, the PDO thread group demonstrated a statistically significant increase in TGF-ß1 compared to the HA group. CONCLUSION: This in vivo study demonstrated the stable application of solid-type pure HA threads and their potential for inducing collagen production, while also yielding a low inflammatory response. The findings highlight the promising applications of solid-type HA in the field of cosmetic dermatology. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Polypropylene and Polydioxanone in the Hemitransdomal Suture: A Novel Rabbit Ear Cartilage Model.

BACKGROUND: Lower lateral cartilage reshaping is one of the basic steps in rhinoplasty. Hemitransdomal suture is frequently used for dome narrowing. Different suture materials can be used for hemitransdomal suture. In this study, we investigated the effectiveness of polypropylene and polydioxanone in hemitransdomal suture by designing a new experimental model in the rabbit ear cartilage. METHODS: Twelve young adult male New Zealand White rabbits were used. The bipedicled inverted-U-shaped cartilage was elevated in each ear of the rabbits. Two hemitransdomal sutures were applied using 5-0 polypropylene on one ear and 5-0 polydioxanone on the other ear randomly. A 5 mm high cartilage mound was created with two hemitransdomal sutures on each side. The sample size was twelve both in the polypropylene group and the polydioxanone group (n = 12). All animals were sacrificed after three months. Cartilage mound heights were measured. The samples were examined histologically regarding fibroadipose tissue, inflammation, foreign body granuloma, cartilage degeneration, and the presence of inclusion cyst. RESULTS: Cartilage mound height was significantly higher in the polypropylene group than in the polydioxanone group at the end of the third month [3.75 mm (± 0.68) vs. 3.03 mm (± 0.69); p < 0.05]. There was no significant difference between the two groups in histological analysis (p > 0.05). CONCLUSIONS: Polypropylene suture may be more effective in maintaining the shape given to the dome by hemitransdomal sutures in rhinoplasty. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Advanced Facial Rejuvenation: Synergistic Effects of Lower Blepharoplasty and Ultrasound Guided Mid-Face Lift Using Polydioxanone (PDO) Threads.

BACKGROUND: Traditional facial aging surgeries have risks and extended recovery times, leading to a demand for minimally invasive alternatives. PDO (polydioxanone) threads, which are absorbable sutures that stimulate collagen production and tissue contraction, offer improved aesthetic outcomes. This paper evaluates the combined use of PDO thread mid-cheek lift and lower blepharoplasty for facial rejuvenation. METHODS: This retrospective study compared outcomes in patients undergoing lower blepharoplasty combined with a mid-face lift using PDO threads versus those undergoing only lower blepharoplasty. Focused on individuals with baggy lower eyelids and pronounced nasolabial folds, outcome measures included the Modified Fitzpatrick wrinkle scale, Allergan® midface volume deficit scale, Width of inter zygomatic distance, Patient and Observer Scar Assessment Scale, and patient satisfaction questionnaires, assessed at baseline, 3 months, and 1 year postoperatively. RESULTS: The combined procedure demonstrated superior aesthetic outcomes and higher patient satisfaction compared to lower blepharoplasty alone. Improvements were more significant in wrinkle reduction, midface volume, and inter-zygomatic distance in the combined procedure group. Although the combined procedure had a longer mean operation time, scar assessment scores were similar between both groups, with no complications reported. CONCLUSION: The combination of lower blepharoplasty and mid-face lift using PDO threads is a comprehensive and effective approach for facial rejuvenation. It significantly enhances wrinkle reduction, mid-face lifting, and patient satisfaction. Ultrasound-guided thread lifting, a method of assessing and performing mid-face lifting, proves to be safe and efficient. This approach holds promise as a future option in cosmetic anti-aging surgery, presenting a minimally invasive alternative with natural-looking results and reduced downtime. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy.

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.

Transurethral ventral inlay buccal mucosa graft urethroplasty: technique and intermediate outcomes.

OBJECTIVE: To outline our step-by-step surgical technique for a transurethral ventral buccal mucosa graft inlay urethroplasty to treat fossa navicularis and distal urethral strictures. METHODS: The transurethral ventral inlay urethroplasty is accomplished in four steps. First, after obtaining proper exposure the cicatrice is excised via a transurethral ventral urethrotomy until the lumen is at least 24fr. Second, double arm 6-0 polydioxanone suture is used to deliver the triangular buccal mucosal graft to the proximal extent of the urethrotomy and secured externally. Third, the graft is secured to the meatus with 5-0 polyglactin sutures and additional 6-0 double arm polydioxanone sutures are used to quilt the graft for spread fixation. Finally, a 16fr silicone catheter is placed. Patients are discharged the same day and return for void trial after one week. A retrospective, single institution review was conducted to include all patients who underwent this procedure with a minimum of 1 year follow-up. Patients were analyzed for recurrences, and pre- and post-operative urine flow rates, post void residuals, and patient questionnaires were also reviewed. RESULTS: 44 patients met our inclusion criteria. Median surgical time was 120 minutes. At a mean follow up of 36 months (IQR 22-50) 95% of patients are patent without additional interventions. The 2 patients that did have stricture recurrence were found to have urethral stenosis that extended more proximally, and both were successfully treated with a dorsal onlay buccal urethroplasty. There were significant improvements in urine flow rate, post void residuals, international prostate symptom score and quality of life scores post operatively. There was no difference in post operative sexual function scores. CONCLUSION: This minimally invasive transurethral ventral urethroplasty has excellent intermediate term outcomes in terms of traditional objective measures of urethroplasty success and patient reported outcomes.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non-absorbable Suture Materials-An in Vitro Study.

INTRODUCTION: Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials. AIM: To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials. METHODS: The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7 days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment. RESULTS: Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only. CONCLUSION: In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings.

Airway Stents from Now to the Future: A Narrative Review.

Airway stent insertion is important for patients with airway stenosis. Currently, the most widely used airway stents in clinical procedures are silicone and metallic stents, which offer patients effective treatment. However, these stents composed of permanent materials need to be removed, subjecting patients to invasive manipulation once more. As a result, there is a growing demand for biodegradable airway stents. Biodegradable materials for airway stents are now available in two types: biodegradable polymers and biodegradable alloys. Polymers that include poly (l-lactic acid), poly (D, l-lactide-co-glycolide), polycaprolactone, and polydioxanone are the ultimate metabolites which are generally carbon dioxide and water. Magnesium alloys are the most often utilized metal biodegradable materials for airway stents. The stent's mechanical properties and rate of degradation vary as a result of the different materials, cutting techniques, and structural configurations. We summarized the information above from recent studies on biodegradable airway stents conducted in both animals and humans. There is great potential for clinical applications for biodegradable airway stents. They avoid damage to the trachea during removal and reduce complications to some extent. However, several significant technical difficulties slow down the development of biodegradable airway stents. The efficacy and safety of different biodegradable airway stents still need to be investigated and proved.

Do Antiseptic Coated Sutures Reduce Colo-Colonic Anastomotic Leaks?

BACKGROUND: Colorectal anastomotic leaks remain one of the most significant complications following colorectal surgery. Various interventions to reduce anastomotic leaks have been investigated, however few have resulted in a significant improvement. To date antiseptic coated monofilament sutures for sutured bowel anastomoses have not been assessed, hence this study was undertaken to investigate whether or not triclosan impregnated polydioxanone suture material (PDS) results in fewer anastomotic leaks. METHODS: A rabbit colo-colonic anastomotic model was developed to compare the tensile strength and local inflammatory response between triclosan coated PDS and uncoated PDS. RESULTS: Of the 42 anastomoses there were 4 (9.5%) leaks. Of the remaining 38 anastomoses neither the leak pressures, degree of bowel wall inflammation or fibrosis were statistically different (P = .11; .813 and .658 respectively) when comparing the two suture materials. CONCLUSIONS: In an animal model, triclosan coated PDS is as safe as uncoated PDS in performing colo-colonic anastomosis.

Comparison of incisional bursting strength of a bidirectional absorbable knotless suture material versus a standard continuous absorbable suture material for closure of the equine linea alba.

OBJECTIVE: To evaluate the use of bidirectional knotless barbed suture material for closure of the equine linea alba. STUDY DESIGN: Laboratory study. ANIMAL OR SAMPLE POPULATION: Adult light horse cadavers (n = 24). METHODS: A 25 cm incision was made through the linea alba, and a 200 L polyurethane bladder was positioned within the abdomen. The linea alba was closed either using USP2/EP5 bidirectional polydioxanone barbed suture or USP2/EP5 standard polydioxanone suture in a simple continuous pattern. Closure time was recorded for each suture type. The bladder was air-insufflated at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and wound failure modes were recorded. Suture length, closure time, bursting pressure, and failure modes were compared using Welch-Aspin t-tests. RESULTS: The incisional bursting pressure was comparable between the two groups (p > .05). Less suture material (p < .01) was required with the barbed suture than the standard suture. Closure time was less for the barbed suture than the standard suture (p < .01). Suture failure was the main failure mode in both groups (83% cases). CONCLUSIONS: Closure of the equine linea alba using bidirectional barbed suture material reduced the amount of foreign material in the wound and decreased closure time without compromising incisional strength. CLINICAL RELEVANCE: Bidirectional barbed suture material could be considered as an alternative to standard suture materials for closure of the equine line alba.

Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery.

BACKGROUND: Breast revision surgeries are complex cases requiring greater pocket control than primary surgeries. Intraoperative techniques to maximize pocket integrity are crucial to achieving an aesthetic result in revisions with implants. OBJECTIVES: Uniform utilization of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has, to our knowledge, never before been described. METHODS: A high-volume (n = 104) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision-augmentations with vertical or wise-pattern mastopexies (n = 74), revision-augmentation without mastopexies (n = 25), and revision without implant exchange (n = 5). Each case employed at least 1 sheet of PDO mesh, with a small set (n = 4) receiving 2 sheets. Patients were followed up (range, 3-19 months), with 3 months minimum follow-up to assess outcomes. RESULTS: The average length of follow-up was 8.8 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range, 1-7). A total 89.4% of patients received an increase in implant volume (average change, +165.2 Cc); 87.5% of patients had favourable aesthetic outcomes, and 12.5% of patients were reoperated on (including reoperations for complications and/or aesthetic reasons). There were 13 complications in the cohort, and no mesh-related complications. CONCLUSIONS: PDO mesh is a safe and effective method of increasing pocket control in breast revision. Supplemental soft-tissue support allowed greater implant volumes to be employed, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics.

Restoration Liposuction of the Abdomen: High-Definition Liposuction With Umbilicus and Lower Abdomen Improvement Using Polydioxanone Threads.

BACKGROUND: Abdominal high-definition liposuction has been practiced for many years. However, problems such as low-lying, "sad-looking" umbilici and lower abdominal "pooches" remain unresolved. Additionally, the waistline, as the pivotal point connecting the chest and hips, deserves more attention and improvement. OBJECTIVES: The aim of this study was to use polydioxanone (PDO) threads after liposuction: (1) to improve the shape and position of the umbilicus permanently; (2) to tighten the lower abdomen permanently; and (3) to redefine "high-definition" liposuction. METHODS: All patients underwent high-definition liposuction of the abdomen and waist. After liposuction, bidirectional, barbed PDO threads were placed in the upper central abdomen. The threads were pulled to cinch the upper abdominal skin and then tied. The resulting umbilicus elevation was measured for up to 12 months. Higher waistlines were also created to match higher-positioned umbilici. RESULTS: Fifty-two female subjects were included. The range of umbilicus elevation at 12 months was 0.8 to 3.6 cm. Most umbilici were converted to vertical orientation, and lower abdomens became lengthened, flattened, and tightened. Moreover, the enhanced waistlines and body curves created better body proportions. CONCLUSIONS: This technique results in permanent elevation and shape enhancement of both umbilicus and lower abdomen. In addition, because the umbilicus is raised, a higher waistline can be created without any discordance, making the lower limbs appear longer. Overall, the maneuvers contributed to the restoration/rejuvenation of the abdomen and created a better overall body shape and proportion.

Single cell multi-omics characterise discrete human tendon cells populations that persist in vitro and on fibrous scaffolds.

Chronic tendinopathy represents a growing healthcare burden in the ageing global population. Curative therapies remain elusive as the mechanisms that underlie chronic inflammation in tendon disease remain unclear. Identifying and isolating key pathogenic and reparative cells is essential in developing precision therapies and implantable materials for improved tendon healing. Multiple discrete human tendon cell populations have been previously described ex vivo. To determine if these populations persist in vitro, healthy human hamstring tenocytes were cultured for 8 d on either tissue culture plastic or aligned electrospun fibres of absorbable polydioxanone. Novel single-cell surface proteomics combined with unbiased single-cell transcriptomics (CITE-Seq) was used to identify discrete tenocyte populations. 6 cell populations were found, 4 of which shared key gene expression determinants with ex vivo human cell clusters: PTX3_PAPPA, POSTN_SCX, DCN_LUM and ITGA7_NES. Surface proteomics found that PTX3_PAPPA cells were CD10+CD26+CD54+. ITGA7_NES cells were CD146+ and POSTN_SCX cells were CD90+CD95+CD10+. Culture on the aligned electrospun fibres favoured 3 cell subtypes (DCN_LUM, POSTN_SCX and PTX3_ PAPPA), promoting high expression of tendon-matrix-associated genes and upregulating gene sets enriched for TNF-a and IL-6/STAT3 signalling. Discrete human tendon cell subpopulations persisted in in vitro culture and could be recognised by specific gene and surface-protein signatures. Aligned polydioxanone fibres promoted the survival of 3 clusters, including pro-inflammatory PTX3-expressing CD10+CD26+CD54+ cells found in chronic tendon disease. These results improved the understanding of preferred culture conditions for different tenocyte subpopulations and informed the development of in vitro models of tendon disease.

Examination of abdominal wall perfusion using varying suture techniques for midline abdominal laparotomy closure.

BACKGROUND: With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we studied the effect of different suture materials and closure techniques on abdominal wall perfusion. METHODS: Fifteen porcine subjects underwent midline laparotomy, bilateral skin flap creation, and three separate 7 cm midline fascial incisions. Animals underwent fascial closure with 5 different techniques: (1) Running 0-PDS® II (polydioxanone) Suture with large bites; (2) Running 0-PDS II Suture with small bites; (3) Interrupted figure-of-eight (8) PDS II Suture, (4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device large bite; (5) Running 0-STRATAFIX Symmetric PDS Plus Device small bites. ICG-FA signal intensity was recorded prior to fascial incision (baseline), immediately following fascial closure (closure), and at one-week (1-week.). Post-mortem, the abdominal walls were analyzed for inflammation, neovascularity, and necrosis. RESULTS: PDS II Suture with small bites, fascial closure at the caudal 1/3 of the abdominal wall, and the 1-week time period were all independently associated with increased tissue perfusion. There was also a significant increase in tissue perfusion from closure to 1-week when using small bites PDS II Suture compared to PDS II Suture figure-of-8 (p < 0.001) and a trend towards significance when compared with large bites PDS II Suture (p = 0.056). Additionally, the change in perfusion from baseline to 1 week with small bites was higher than with figure of 8 (p = 0.002). Across all locations, small bite PDS II Suture has greater total inflammation than figure of 8 (p < 0.001). CONCLUSIONS: The results suggest that the small bite technique increases abdominal wall perfusion and ICG-FA technology can reliably map abdominal wall perfusion. This finding may help explain the reduced incisional hernia rates seen in clinical studies with the small bite closure technique.

Application of Polydioxanone Sutures in the Nuss Procedure.

BACKGROUND/PURPOSE: The Nuss procedure is the most common surgical repair for pectus excavatum (PE). Surgical steel wires are used in some modifications of the Nuss procedure to attach one or both ends of a support bar to the ribs. During follow-up, wire breakage was found in some cases. Patients with wire breakage may undergo prolonged bar removal surgery and may be exposed to excessive radiation.In this study, we had a series of patients who received polydioxanone suture (PDS) fixations instead of steel wires. This retrospective study was conducted to explore the differences between these two fixation materials in the incidence of related complications and efficacies. Furthermore, we attempted to observe whether the two materials lead to similar surgical efficacy in the Nuss procedure, whether they have divergent effects on the bar removal surgery, and whether PDS can reduce the risks due to steel wire breakage as expected. METHODS: We retrospectively studied PDS and surgical steel wires as fixation materials for the Nuss procedure in children with congenital PE and reviewed the outcomes and complications. A total of 75 children who had undergone Nuss procedure repairs and bar removals from January 2013 to December 2019 were recruited to participate in this study. They were divided into three groups: the PDS group, the unbroken wire (UBW) group, and the broken wire (BW) group, according to the fixation materials and whether the wires had broken or not. Moreover, we selected the duration of operation (DO), intraoperative blood loss (BL), bar displacement (BD), postoperative pain score (PPS), and incision infection as the risk indicators and the postrepair Haller index (HI) as the effectiveness indicator. These indicators were statistically compared to determine whether there were differences among the three groups. RESULTS: One BD occurred in the PDS and BW groups while none took place in the UBW group. No incision infection was found in any of the groups. The PDS group had the shortest DO, while the DO in the UBW group was shorter than that in the BW group (p < 0.05). BL in the PDS group was less than that in the other two groups (p < 0.05). Additionally, no difference was observed in BL between the BW and UBW groups (p > 0.05). The PPS of the PDS group was less than that of the BW group (p < 0.05), whereas no differences were found between the other two groups. No statistical difference emerged in HI among the groups (p > 0.05). CONCLUSION: PDS fixation results in a similar repair outcome and shows certain advantages in the DO, BL, and PPS; also, PDSs are safe and effective in the Nuss procedure. LEVEL OF EVIDENCE: Level III.