Implant-Based Breast Reconstruction with Bovine Pericardium: Our Approach Using Tutopatch® and Review of Literature.

OBJECTIVES: To describe the usage and advantages of bovine pericardium mesh (Tutopatch®) in breast reconstruction and to compare different mesh materials used in immediate breast reconstruction. METHODS: Our study involved a single-center, retrospective analysis of 103 patients (comprising 114 breasts) who underwent immediate implant-based breast reconstruction using bovine pericardium bovine matrix. The procedures were performed by the same surgical team between April 2018 and May 2023. RESULTS: The rates of early and late complications were examined after a median follow-up period of 30.2 ± 5.5 months. The results revealed that the rates of early complications stood at 9.7%, while late complications were observed in 14.5% of the cases. The most common late complication was seroma formation (7.7%) which six were resolved without any surgical intervention. CONCLUSION: Tutopatch® can be used as an extension of the muscle to cover the prosthesis. It forms an extra layer over the silicone implant that helps to decrease the complications as capsular contracture and implant exposure. It also represents a significant 85 % reduction in cost when compared to a similar-sized mesh materials. LEVEL OF EVIDENCE IV: 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 www.springer.com/00266 .

Bovine pericardium membrane (TutoPatch) for emergency repair of total corneal melting over an infected corneal graft.

Purpose: Corneal perforation due to severe melting is a very dangerous, sight-threatening condition requiring immediate management due to the high risk of endophthalmitis and critical hypotony. In the case of perforated corneal grafts, retransplantation is usually postponed to avoid the detrimental effects of inflammation on the new graft. We describe the first case of the use of a TutoPatch graft for emergency replacement of a lamellar graft perforation over acute infectious total melting. Observations: A 42-year-old male patient presented to the Emergency Department with pain in the left eye, which was red photophobic. He had been treated with bilateral deep anterior lamellar keratoplasty (DALK) for advanced keratoconus 5 years previously and had been experiencing recurrent corneal ulcers in the left eye within the last 8 months. Clinical examination documented corneal perforation over acute infectious melting involving the total graft surface in the left eye. The infected graft was removed along with the perforated infected residual Descemet membrane, and a double-layer TutoPatch covering was sutured to the host's margin with 10.0 nylon. The covering was left in place for three weeks, allowing the patient to undergo retransplant three weeks later without complications. Conclusions and importance: TutoPatch covering can be safely used as an easy-to-preserve emergency material for a temporary bridge to retransplantation in large acute infectious corneal melting.

The use of lyophilized bovine pericardium (Tutopatch®) in the management of third nerve palsy following prior conventional strabismus surgery - a case series.

To study the secondary management of strabismus due to third nerve palsy using bovine pericardium (Tutopatch®) when previous conventional surgical therapy had failed. Review of our clinic records of selected patients with third nerve palsy, in whom residual deviation had been managed using Tutopatch® after previous surgical correction. The squint angle was measured preoperatively, and at 1 day, 3 months, and if possible 6 months postoperatively. Nine patients were enrolled in this study. One patient had mainly residual vertical deviation and was corrected with tendon elongation of the contralateral superior rectus. Three patients were operated on with tendon elongation of the lateral rectus muscle with or without medial rectus muscle resection and/or advancement (Group 1). Lateral rectus splitting after tendon elongation in addition to the resection and/or advancement of the medial rectus was performed in five patients with complete third nerve palsy (Group 2). In Group 1, the preoperative median squint angle was -20° (range -17° to -25°), which improved postoperatively to -4.5° (range -12° to +3°). In Group 2, the preoperative horizontal and vertical median squint angles were -27° (range -20° to -40°) and 0.5° (range 0° and 20°), respectively. Postoperatively, they had improved to -12.5° (range-2° to -25°), and 1.5° (range 0° to 7°), respectively. Two patients of Group 2 were re-operated due to residual exotropia. No postoperative complications were observed in any patient. In this small series several complex re-do situations of patients with third nerve palsy were evaluated in which Tutopatch® markedly improved outcomes after an initially ineffective surgical management. For better evaluation of its usefulness a study with more patients is recommended.

An alternative to skin graft for superficial surgical defect in oral cancer surgery / Uma alternativa ao enxerto de pele para defeitos cirúrgicos superficiais em cirurgia de câncer oral

Abstract Introduction: After surgery for oral cavity cancer, superficial surgical defects are usually covered with a skin graft that can be harvested with different thicknesses depending on the reconstructive need. Despite its popularity and efficacy, this solution has the disadvantage of excessive harvesting times and scarring of the donor site. Other surgeons have proposed the use of bovine pericardium as a reconstructive solution. Its use in otorhinolaryngology especially after oral cavity surgery has never been reported. Objective: The aim of this manuscript is to present our preliminary experience with the use of a collagen membrane obtained from bovine pericardium in the reconstruction of small and superficial defects after transoral resection of oral cavity tumors. Methods: A bovine collagen membrane was used to cover surgical defects in 19 consecutive patients undergoing transoral resection of small/superficial oral cancers. Photographs were obtained in the postoperative period to follow the healing process. We analyzed the pro and cons of this tool, recorded data on postoperative chewing-, speechand taste-related quality of life, and tested the most appropriate settings providing the best reconstructive result. Results: The bovine collagen membrane allowed us to cover surgical defects of varying size in different oral sites. Shaping and placement proved to be simple. The membrane facilitated physiologic tissue repair: after one month it was completely absorbed and replaced by the patient's own mucosa. No adverse features were observed in the cohort. Conclusion: A bovine collagen membrane can represent a fast and easy solution in cases of split-thickness defect. Unlike a skin graft, it is not associated with donor site morbidity and allows the patient's own mucosa to be restored with a more physiological result.

Resumo Introdução: Os defeitos cirúrgicos superficiais pós-cirurgia para câncer de cavidade oral geralmente são cobertos com um enxerto de pele que pode ser colhido com diferentes espessuras, depende das necessidades de reconstrução. Apesar de sua popularidade e eficácia, essa solução tem a desvantagem dos tempos excessivos de colheita e cicatrização do local doador. Outros cirurgiões propuseram o uso do pericárdio bovino como solução reconstrutiva, enquanto seu uso em otorrinolaringologia, especialmente após cirurgia de cavidade oral, nunca foi relatado. Objetivo: Apresentar nossa experiência preliminar com o uso de uma membrana de colágeno obtida do pericárdio bovino, na reconstrução de defeitos pequenos e superficiais após resseçcão transoral de tumores da cavidade oral. Método: Uma membrana de colágeno bovino foi usada para cobrir defeitos cirúrgicos em 19 pacientes consecutivos submetidos à resseçcão transoral de câncer oral pequeno/superficial. As fotografias foram obtidas no pós-operatório para acompanhar o processo de cicatrização. Analisamos os prós e contras desse enxerto, registramos dados sobre a qualidade de vida relacionada à mastigação, fala e paladar no pós-operatório e testamos as configurações mais apropriadas, para proporcionar o melhor resultado reconstrutor. Resultados: A membrana de colágeno bovino nos permitiu cobrir defeitos cirúrgicos de tamanhos variados nos diferentes sítios orais. A modelagem e a colocação demonstraram ser simples. A membrana guiou o reparo fisiológico do tecido e após um mês foi completamente absorvida e substituída pela mucosa do próprio paciente. Não foram observadas características adversas na coorte. Conclusão: Uma membrana de colágeno bovino pode representar uma solução rápida e fácil em casos de defeitos de espessura dividida. Ao contrário de um enxerto de pele, ele não está associado à morbidade do local doador e permite que a mucosa do próprio paciente seja restaurada com um resultado mais fisiológico.

Tendon elongation with bovine pericardium in strabismus surgery-indications beyond Graves' orbitopathy.

BACKGROUND: For some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch®) in indications other than Graves' orbitopathy in which it is already widely used. METHODS: We reviewed the records of all patients who underwent surgery with Tutopatch® in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves' orbitopathy were excluded. RESULTS: From 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3-75)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane's retraction syndrome with eso- (type I: 16)/exodeviation (type II: 2, type III: 1), 6th (7)/3rd nerve palsy (7), Möbius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1-5 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10Δ (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35Δ (16 to 45Δ) to 9Δ (0 to 40Δ), for Duane's retraction syndrome from 27.5Δ (9 to 40Δ) to 7Δ (0 to 40Δ), and for sixth and third nerve palsies from 43Δ (20 to 75Δ) to 18Δ (4 to 40Δ). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30Δ (20 to 45Δ) to 4Δ (1 to 22Δ). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered. CONCLUSIONS: Strabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.

An alternative to skin graft for superficial surgical defect in oral cancer surgery.

INTRODUCTION: After surgery for oral cavity cancer, superficial surgical defects are usually covered with a skin graft that can be harvested with different thicknesses depending on the reconstructive need. Despite its popularity and efficacy, this solution has the disadvantage of excessive harvesting times and scarring of the donor site. Other surgeons have proposed the use of bovine pericardium as a reconstructive solution. Its use in otorhinolaryngology especially after oral cavity surgery has never been reported. OBJECTIVE: The aim of this manuscript is to present our preliminary experience with the use of a collagen membrane obtained from bovine pericardium in the reconstruction of small and superficial defects after transoral resection of oral cavity tumors. METHODS: A bovine collagen membrane was used to cover surgical defects in 19 consecutive patients undergoing transoral resection of small/superficial oral cancers. Photographs were obtained in the postoperative period to follow the healing process. We analyzed the pro and cons of this tool, recorded data on postoperative chewing-, speech- and taste-related quality of life, and tested the most appropriate settings providing the best reconstructive result. RESULTS: The bovine collagen membrane allowed us to cover surgical defects of varying size in different oral sites. Shaping and placement proved to be simple. The membrane facilitated physiologic tissue repair: after one month it was completely absorbed and replaced by the patient's own mucosa. No adverse features were observed in the cohort. CONCLUSION: A bovine collagen membrane can represent a fast and easy solution in cases of split-thickness defect. Unlike a skin graft, it is not associated with donor site morbidity and allows the patient's own mucosa to be restored with a more physiological result.

Use of processed bovine pericard in peripheral nerve surgery.

OBJECTIVE: Nerve damage often means a loss of the epi- and perineural sheaths, an adherence to the surrounding tissue and a loss of smooth movements. This leads to pain and functional deficits. Creating a gliding apparatus for damaged nerves is a possibility to restore physiological function and interrupt the vicious circle of pain. PATIENTS AND METHODS: We investigated nine patients who were undergoing peripheral nerve surgery in the forearm and upper arm region. Surgeries included six revisions due to scar-adherence caused by bone fracture surgery, two revisions due to previous nerve compression syndrome surgery and one revision after complete severing of the nerve and previous emergency surgery of the vessels. In each case, the nerve was freed from enveloping scar tissue and a processed bovine pericard (Tutopatch®) was used to wrap or cover parts of the affected nerve. The patients were examined clinically and by high-resolution sonography (HRS) after surgery. RESULTS: All patients showed improvement in respect of function and of pain. There were no adverse reactions as a consequence of the material used. HRS showed that the Tutopatch melds with its environment, and it did not lead to re-scarring of the nerve. CONCLUSION: Tutopatch appears to be a suitable allogeneic material for nerve-wrapping.

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture.

PURPOSE: To compare the use of human donor sclera with bovine pericardium as patch graft material for a glaucoma drainage device (GDD), with respect to the incidence of tube exposure, and to study the role of a drainage suture. METHODS: All GDD surgeries between 2010 and 2014 performed at the VU Medical Center were examined in this comparative, retrospective cohort study. A total of 244 cases were included; 163 in the human donor sclera cohort and 81 in the bovine pericardium cohort with a median follow-up of 31 and 36 months, respectively. The primary outcome measure was occurrence of tube exposure. Survival analysis for tube exposure was carried out and Kaplan-Meier curves compared. Secondary outcomes were postoperative intraocular pressure (IOP), number of glaucoma medications and the effect of a drainage suture. RESULTS: In the bovine pericardium cohort, eleven (13.6%) eyes developed tube exposure compared to none in the human donor sclera cohort. Their Kaplan-Meier survival curves differed significantly from each other (χ² = 21.1, p < 0.001, log-rank test). Mean IOP and number of glaucoma medications did not differ significantly between patch graft materials at three months of follow-up. The use of a drainage suture directly lowered IOP after surgery in both cohorts. Within the bovine pericardium cohort, eyes with a drainage suture experienced more tube exposure, although this difference was not statistically significant (p = 0.09). CONCLUSION: Human donor sclera leads to less tube exposure than bovine pericardium. A drainage suture directly lowers IOP after surgery. With bovine pericardium, but not with donor sclera, exposure tends to be enhanced by a drainage suture.

Solid Platelet Rich Plasma in Corneal Surgery.

UNLABELLED: Solid eye platelet-rich plasma (E-PRP) concentrates platelets in a small volume of plasma which contains a high concentration of important growth factors and cell adhesion molecules. These cell adhesion molecules and growth factors occupy a major role in wound healing and enhance the physiological procedure at the site of the injury or the surgery. There are different materials used to tectonically maintain the solid clot attached at the site where treatment is necessary. Although AM may be used for this purpose, other biomaterials such a bovine pericardium or autologous fibrin membrane are at least as effective with less interdonor variations, no biological hazards, providing a better surgical alternative than the biologically so variable amniotic membrane patch. Solid platelet-rich plasma in the form obtained in ophthalmology, E-PRP, is a reliable and effective surgical coadjuvant to promote corneal wound healing in severe corneal ulcers and corneal perforations, and may be associated with other ocular surface reconstruction procedures. FUNDING: Supported in part by a grant from the Spanish Ministry of Science and Innovation, Centro para el Desarrollo Tecnológico Industrial (CDTI), CENIT: "Customized Eye Care", CeyeC (CEN-20091021).

A Modified One-Stage Early Correction of Blepharophimosis Syndrome Using Tutopatch Slings.

PURPOSE: To investigate the efficacy of a one-stage early correction of blepharophimosis-ptosis-epicanthus inversus syndrome (BPES), using bovine pericardium derived membrane (TUTOPATCH(®)) for the frontalis suspension. METHODS: We prospectively studied 12 eyes from 6 patients (median age 14 months) affected by BPES with severe ptosis. All patients were submitted to a one-stage early correction of ptosis (frontalis suspension with TUTOPACH(®)) and telecanthus and epicanthus inversus. Upper margin reflex distance (MRD), nasal inner intercanthal distance (IICD), horizontal fissure length (HFL), and IICD/HFL ratio were evaluated using photographs. RESULTS: The Wilcoxon signed-rank test showed a statistically significant difference between pre- and post-operative MRD, IICD, HFL, and the IICD/HFL ratio. CONCLUSION: An early TUTOPATCH-assisted frontalis suspension, together with the correction of telecanthus and epicanthus inversus, is an effective procedure for BPES cases with severe ptosis.