Tag: Soft Tissue Surgery

The speed of surgery after a hip fracture may have a significant impact on outcomes for older patients, and faster may be better, say researchers at McMaster University. For seniors, hip fractures can cause serious complications that may result in death or admission to long-term care facilities for some people who previously lived at home. Hip fractures cause pain, bleeding and immobility and activate patient’s coagulation and stress systems which can lead to medical complications in people awaiting surgery. In many countries, including Canada, waits for hip surgery can be 24 hours or longer, mainly because of pre-surgery clearance procedures and lack of operating rooms. However, during the scientific study of 60 people aged 45 years or older in Canada and India, half received accelerated surgery within six hours and half had standard care of surgery 24 hours after diagnosis with a hip fracture. Among patients receiving standard care, 47% suffered a major complication of death, heart attack, stroke, pneumonia, blood clot or major bleeding event. However, only 30% of the patients in the accelerated surgery group suffered one of these complications. “We believe that the shortest time possible to treatment may provide the greatest potential for benefit, as is the case in acute heart attack and stroke,” said Dr. P.J. Devereaux, an associate professor of medicine and epidemiology at the Michael G. DeGroote School of Medicine at McMaster and co-principal investigator of the pilot trial. Dr. Mohit Bhandari, a professor of surgery of the McMaster medical school and co-principal investigator, added: “This pilot provides encouraging evidence that accelerated surgery may substantially improve outcomes in these patients.”

Science Daily
December 10, 2013

Original web page at Science Daily

Two knee surgeons at University Hospitals Leuven have discovered a previously unknown ligament in the human knee. This ligament appears to play an important role in patients with anterior cruciate ligament (ACL) tears. ‪Despite a successful ACL repair surgery and rehabilitation, some patients with ACL-repaired knees continue to experience so-called ‘pivot shift’, or episodes where the knee ‘gives way’ during activity. For the last four years, orthopedic surgeons Dr Steven Claes and Professor Dr Johan Bellemans have been conducting research into serious ACL injuries in an effort to find out why. Their starting point: an 1879 article by a French surgeon that postulated the existence of an additional ligament located on the anterior of the human knee. That postulation turned out to be correct: the Belgian doctors are the first to identify the previously unknown ligament after a broad cadaver study using macroscopic dissection techniques. Their research shows that the ligament, which was given the name anterolateral ligament (ALL), is present in 97 per cent of all human knees. Subsequent research shows that pivot shift, the giving way of the knee in patients with an ACL tear, is caused by an injury in the ALL ligament. Some of the conclusions were recently published in the Journal of Anatomy. The Anatomical Society praised the research as “very refreshing” and commended the researchers for reminding the medical world that, despite the emergence of advanced technology, our knowledge of the basic anatomy of the human body is not yet exhaustive. ‪The research questions current medical thinking about serious ACL injuries and could signal a breakthrough in the treatment of patients with serious ACL injuries. Dr Claes and Professor Bellemans are currently working on a surgical technique to correct ALL injuries. Those results will be ready in several years.

‪Science Daily
November 26, 2013

Original web page at Science Daily

Millions of people with scars suffer from pain, discomfort, and inability to perform regular activities. Some may have to revert to addicting pain medicine to get rid of their ailments. Now, and with a new methodology, such problems can be treated successfully. A technique using injection of the patient’s own fat cells is an effective treatment for hard, contracted scars resulting from burns or other causes, reports a study in the September issue of The Journal of Craniofacial Surgery, edited by Mutaz B. Habal, MD, FRCSC, and published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. Dr. Marco Klinger and coauthors of Università degli Studi di Milano report good results with fat grafting in hundreds of patients with difficult-to-treat scars causing pain and limited motion. “For scar treatment, where medical and surgical therapies seem to be ineffective especially in the long term, autologous fat graft has proven to be a new chance to repair tissue damage,” the researchers write. “Fat Grafting Shows Promise as Treatment for Scars” Dr. Klinger and colleagues used autologous fat grafting to treat persistent scarring problems in nearly 700 patients over six years. (“autologous” means using the patient’s own tissues.) All patients had abnormal, painful scars causing hardening or tightening of the skin, often with limitation of motion. The scars — resulting from burns, surgery, or other causes — had not improved with other treatments.

The fat grafting procedure began with liposuction to collect a small amount of the patient’s own fat tissue — usually from the abdomen or hips. After processing, surgeons reinjected the fat cells under the skin in the area of scarring. Fat was distributed in different directions, with the goal of creating a “web” of support for scarred, damaged skin. Fat grafting led to significant improvement “both from an aesthetic and functional point of view,” according to Dr. Klinger and co-authors. The skin in the scarred area became “softer and more flexible and extensible, and very often color seemed similar to the surrounding unharmed skin.” After fat grafting, the patients had decreased pain and increased scar elasticity. Improvement began within two weeks, continued through three months, and persisted through one year and beyond. In a subgroup of patients, objective testing of skin hardness and clinical ratings by doctors and patients provided further evidence of treatment benefits. Fat cells lead to improved function as well as appearance. For example, in patients with scarring after burns to the face, fat grafting led to improved facial motion.

Fat grafting helped solve other difficult surgical problems as well. In one case, a breast cancer patient was left with hard, painful scars after complications from breast reconstruction. Treatment with fat grafting allowed a successful second breast reconstruction to be performed. In recent years, there has been renewed interest in techniques using the patient’s own fat for reconstructive and cosmetic plastic surgery. The new experience suggests that fat grafting may provide an effective new “regenerative medicine” technique for patients with difficult-to-treat scars. It’s not yet clear exactly how fat grafting exerts its benefits in scarred tissues. One factor may be the fact that fat tissue includes stem cells, which can develop into many different types of cells active in the wound healing and tissue repair process.

Science Daily
October 15, 2013

Original web page at Science Daily

Every day, their baby stopped breathing, his collapsed bronchus blocking the crucial flow of air to his lungs. April and Bryan Gionfriddo watched helplessly, just praying that somehow the dire predictions weren’t true. “Quite a few doctors said he had a good chance of not leaving the hospital alive,” says April Gionfriddo, about her now 20-month-old son, Kaiba. “At that point, we were desperate. Anything that would work, we would take it and run with it.” They found hope at the University of Michigan, where a new, bioresorbable device that could help Kaiba was under development. Kaiba’s doctors contacted Glenn Green, M.D., associate professor of pediatric otolaryngology at the University of Michigan. Green and his colleague, Scott Hollister, Ph.D., professor of biomedical engineering and mechanical engineering and associate professor of surgery at U-M, went right into action, obtaining emergency clearance from the Food and Drug Administration to create and implant a tracheal splint for Kaiba made from a biopolymer called polycaprolactone.

On February 9, 2012, the specially-designed splint was placed in Kaiba at C.S. Mott Children’s Hospital. The splint was sewn around Kaiba’s airway to expand the bronchus and give it a skeleton to aid proper growth. Over about three years, the splint will be reabsorbed by the body. The case is featured today in the New England Journal of Medicine. “It was amazing. As soon as the splint was put in, the lungs started going up and down for the first time and we knew he was going to be OK,” says Green. Green and Hollister were able to make the custom-designed, custom-fabricated device using high-resolution imaging and computer-aided design. The device was created directly from a CT scan of Kaiba’s trachea/bronchus, integrating an image-based computer model with laser-based 3D printing to produce the splint. “Our vision at the University of Michigan Health System is to create the future of health care through discovery. This collaboration between faculty in our Medical School and College of Engineering is an incredible demonstration of how we achieve that vision, translating research into treatments for our patients,” says Ora Hirsch Pescovitz, M.D., U-M executive vice president for medical affairs and CEO of the U-M Health System.

“Groundbreaking discoveries that save lives of individuals across the nation and world are happening right here in Ann Arbor. I continue to be inspired and proud of the extraordinary people and the amazing work happening across the Health System.” Kaiba was off ventilator support 21 days after the procedure, and has not had breathing trouble since then. “The material we used is a nice choice for this. It takes about two to three years for the trachea to remodel and grow into a healthy state, and that’s about how long this material will take to dissolve into the body,” says Hollister. “Kaiba’s case is definitely the highlight of my career so far. To actually build something that a surgeon can use to save a person’s life? It’s a tremendous feeling.” The image-based design and 3D biomaterial printing process can be adapted to build and reconstruct a number of tissue structures. Green and Hollister have already utilized the process to build and test patient specific ear and nose structures in pre-clinical models. In addition, the method has been used by Hollister with collaborators to rebuild bone structures (spine, craniofacial and long bone) in pre-clinical models.

Severe tracheobronchomalacia is rare. About 1 in 2,200 babies are born with tracheomalacia and most children grow out of it by age 2 or 3, although it often is misdiagnosed as asthma that doesn’t respond to treatment. Severe cases, like Kaiba’s, are about 10 percent of that number. And they are frightening, says Green. A normal cold can cause a baby to stop breathing. In Kaiba’s case, the family was out at a restaurant when he was six weeks old and he turned blue. “Severe tracheobronchomalacia has been a condition that has bothered me for years,” says Green. “I’ve seen children die from it. To see this device work, it’s a major accomplishment and offers hope for these children.” Before the device was placed, Kaiba continued to stop breathing on a regular basis and required resuscitation daily. “Even with the best treatments available, he continued to have these episodes. He was imminently going to die. The physician treating him in Ohio knew there was no other option, other than our device in development here,” Green says. Kaiba is doing well and he and his family, including an older brother and sister, live in Ohio. “He has not had another episode of turning blue,” says April. “We are so thankful that something could be done for him. It means the world to us.”

Science Daily
June 11, 2013

Original web page at Science Daily

Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons — with high costs related to the risk of contracting serious infectious diseases, according to a special article in the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). ASPS Member Surgeon Dr. Kevin C. Chung and colleagues at The University of Michigan Health System, Ann Arbor, review the risks, health impact and costs of “sharps” injuries for surgeons and other operating room personnel. They write, “Increased attention to the health, economic, personal and social implications of these injuries is essential for appropriate management and future prevention.” Nearly 400,000 sharps injuries occur each year in the United States. About 25 percent of injured workers are surgeons — for whom the risk is highest in the operating room. “Despite healthcare policies designed to protect healthcare workers, injuries remain common,” Dr. Chung and colleagues write. Nearly all surgeons will sustain a sharps injury sometime during their career. Medical students and residents are also at high risk; fatigue and inexperience are important risk factors.

The main health concern of sharps injuries is the risk of acquiring a communicable disease from a patient. While HIV is the most-feared result, the risk of infection with hepatitis B virus is actually much higher. Sharps injuries can also have a major psychological impact on the injured person and his or her family — particularly during the time needed to confirm that the injured worker is free of infection, which may take several weeks or months. Once an injury occurs, there are standardized guidelines for post-exposure prevention, depending on whether the patient has any known transmissible infections. Recommendations include antiviral medications for healthcare workers exposed to HIV and hepatitis B or C virus — ideally starting within hours after the injury. As a result of the need for testing and treatment, sharps injuries have a major economic impact. Average costs for testing, follow-up and preventive treatment range from $375 for needlestick exposure from a patient with no known blood-borne illness, up to nearly $2,500 for injuries from a patient with known HIV.

Post-exposure prevention can only be executed if the injury is reported. One study found that 70 percent of surgeons “never or rarely” report sharps injuries. They may feel they “don’t have time” to report, or may misunderstand the risks involved. “Fortunately, the majority of sharps injuries are preventable,” Dr. Chung and colleagues write. Engineered safety devices can prevent many injuries — especially if surgeons and other workers are involved in choosing to use them. Other options include the use of “non-sharp” alternatives, creating safe procedures for passing sharp instruments and wearing double gloves to reduce the risk of infection. Over the years, regulations have been introduced to ensure that proper prevention and reporting strategies are in place. Introduction of the Needlestick Safety and Prevention Act of 2000 led to an overall 38 percent reduction in injuries in all care settings. However, one study reported that the rate of sharps injuries in the operating room actually increased. “Although preventive strategies exist, their success ultimately relies on clinician compliance,” Dr. Chung and coauthors write. The authors hope their review will help to increase awareness of the risks and potential harms of sharps injuries among surgeons and operating room personnel, and to increase awareness of efforts to reduce the risk. They conclude, “Targeting educational initiatives during medical school and training may improve knowledge among surgeons of the safest ways to practice in the operating room, and ensuring compliance among all surgeons in practice can reduce the economic and psychosocial burden of these highly prevalent injuries.”

Science Daily
April 16, 2013

Original web page at Science Daily

Notorious among athletes and trainers as career killers, Achilles tendon injuries are among the most devastating. Now, by carbon testing tissues exposed to nuclear fallout in post WWII tests, scientists have learned why: Like our teeth and the lenses in our eyes, the Achilles tendon is a tissue that does not repair itself. This discovery was published online in The FASEB Journal. “Tendon injury is a very common disease, which hinders many people from enjoying the numerous benefits of sports and recreational activities,” said Katja Heinemeier, Ph.D., a researcher involved in the work from the Institute of Sport Medicine and Center for Healthy Aging at the University of Copenhagen in Denmark. “We hope that these new results will provide the essential knowledge necessary for the development of effective treatments of tendon diseases.” Heinemeier and colleagues made this discovery by taking advantage of carbon-14 spikes resulting from post WWII nuclear bomb tests. Because of these tests, there was a large release of the radioactive carbon-14 (radiocarbon) to the atmosphere between 1955 and 1963. This sudden rise in carbon-14 — called the “bomb pulse” — reached a maximum of twice the natural atmospheric level in 1963, and then gradually dropped to the lower levels over time. This variation is reflected in all human tissue, because humans eat plants (and animals fed on plants) that take up carbon-14 from the atmosphere.

Researchers studied the Achilles tendons from people who had lived during the carbon-14 bomb pulse peak, and found that the high carbon-14 levels of this period had remained in the tendon tissue for decades after. This persistence of radiocarbon can only be explained by the fact that the rate of tissue renewal is extremely slow in the tendon, if it exists at all. In fact, the results showed that the Achilles tendon stays the same after growing ends. In comparison, muscle tissue from the same persons had been constantly renewed and contained no “memory” of the radiocarbon. “While the nation waits to see if another Olympic skier or NFL rookie recovers from serious tendon or ligament damage, this report serves as a cautionary tale to temper expectations,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “When it comes to our tendons, what we have may be all we have. Like our teeth, it’s far better and less painful in the long term to protect them throughout your lifetime than it is to count on a successful recovery.”

Science Daily
March 5, 2013

Original web pages at Science Daily

Injecting specialized cardiac stem cells into a patient’s heart rebuilds healthy tissue after a heart attack, but where do the new cells come from and how are they transformed into functional muscle? Researchers at the Cedars-Sinai Heart Institute, whose clinical trial results in 2012 demonstrated that stem cell therapy reduces scarring and regenerates healthy tissue after a heart attack, now have found that the stem cell technique boosts production of existing adult heart cells (cardiomyocytes) and spurs recruitment of existing stem cells that mature into heart cells. The findings, from a laboratory animal study, are published in EMBO Molecular Medicine online. “We’re finding that the effect of stem cell therapy is indirect. It stimulates proliferation of dormant surviving host heart tissue, and it attracts stem cells already in the heart. The resultant new heart muscle is functional and durable, but the transplanted stem cells themselves do not last long,” said Eduardo Marbán, MD, PhD, director of the Heart Institute. Marbán, the article’s senior author, invented the experimental stem cell procedures and technology tested in humans.

Consistent with previous studies, the researchers found that the heart’s native stem cells are not responsible for the normal replenishment of lost heart cells, but they do contribute to rebuilding heart tissue after heart attack. This study shows that existing heart cells contribute to formation of new heart cells in the normal heart: Through a gradual cycling process, dying heart cells are replaced by new ones. The researchers found that this cycling process escalates in response to heart attack, enabling existing heart cells to assist in the development of new ones. Further, these effects can be amplified through stem cell therapy. The investigational therapy turns on genes that bolster cell production from both sources — existing heart cells and existing stem cells — essentially boosting the heart’s normal means of cell replacement and its natural responses to injury. The injection of stem cells also improves heart structure and function. Marbán and his clinical and research teams in 2009 performed the first procedure in which a heart attack patient’s own heart tissue was used to grow specialized stem cells that were injected back into the heart. Earlier this year, they reported results of a clinical trial that found significant reduction in the size of heart attack-caused scars in patients who underwent the experimental stem cell procedure, compared to others who did not.

Although the preliminary results are positive, the researchers do not know precisely how the research treatment works. “Understanding the cellular sources and mechanisms of heart regeneration is the first step toward refining our strategies to more effectively regenerate healthy tissue after heart attacks,” said Marbán, the Mark S. Siegel Family Professor. The animal study was supported by National Institutes of Health grant R01 HL083109, the California Institute for Regenerative Medicine and the Cedars-Sinai Board of Governors Heart Stem Cell Center. The process to grow cardiac-derived stem cells involved in the clinical trial was developed earlier by Marbán when he was on the faculty of Johns Hopkins University. The university has filed for a patent on that intellectual property and has licensed it to Capricor Inc., a biotechnology company in which Dr. Marbán is a founder and equity holder. The company provided no funding for this study.

Science Daily
February 19, 2013

Original web page at Science Daily

A research effort called the Human Connectome Project is seeking to explore, define, and map the functional connections of the human brain. An update on progress in and upcoming plans for the Human Connectome Project appears in the July issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. Analogous to the Human Genome Project — which mapped the human genetic code — the Human Connectome Project seeks to map “the complete, point-to-point spatial connectivity of neural pathways in the brain,” according to Arthur W. Toga, PhD, and colleagues of David Geffen School of Medicine, University of California Los Angeles. They write, “For neuroscientists and the lay public alike, the ability to assess, measure, and explore this wealth of layered information concerning how the brain is wired is a much sought after prize.” The 100 billion neurons of the human nervous system interconnect to form a relatively small number of “functional neural networks” responsible for behavior and thought. However, even after more than a century of research, there is no comprehensive map of the connections of the human brain.

Historically, studies of the human brain function have employed a “modular” view — for example, “region X is responsible for function Y.” However, a more appropriate approach is to consider which network of two or more “connected or interacting” regions is involved in a given function. Until recently, it was not possible to view networks in the living brain. But newer magnetic resonance imaging (MRI) methods sensitive to water diffusion have made it possible to create detailed maps of the underlying white matter connections between different areas of the brain. This opens the way to new approaches to mapping the structural connectivity of the brain, and showing it in ways that correspond to the brain anatomy. Researchers are working out ways to analyze these data using sophisticated modeling approaches to represent the “nodes and connections” that make up the functional networks of the brain. Such efforts are in their infancy, but these network models are capturing not only the connectedness of brain networks, but also their capacity to process information. Preliminary studies have yielded tantalizing findings, such as a link between more efficient cortical networks and increased intelligence and differences in connectedness between the right and left hemispheres of the brain. “The HCP has recently generated considerable interest because of its potential to explore connectivity and its relationship with genetics and behavior,” Dr. Toga and coauthors write.

The project has far-reaching implications for a wide range of neurological and psychiatric diseases, such as autism, schizophrenia, and Alzheimer’s disease. “The similarities and differences that mark normal diversity will help us to understand variation among people and set the stage to chart genetic influences on typical brain development and decline in human disease,” according to the authors. Dr. Toga and colleagues are making their data available for download and analysis by other researchers on the project website. In the future, the data will be openly available for exploration by the public.

Science Daily
July 24, 2012

Original web page at Science Daily

When you think of Botox injections, you probably think of getting rid of unwanted wrinkles around the eyes or forehead, but recently the US Food and Drug Administration (FDA) approved using the injections to help patients with neurological conditions who suffer from incontinence, or an overactive bladder. Botox injections paralyze the bladder muscle to prevent contractions that cause urgency to urinate or leak. Although medications and behavioral modifications are treatment options, many patients, especially the elderly, do not respond to these methods and need a more aggressive approach. “About 80 percent of patients with neurological conditions, such as spinal cord injuries, Parkinson’s disease and multiple sclerosis, see improvement after about a week, and the results can last four to nine months,” said Charles Nager, MD, co-director of the UC San Diego Women’s Pelvic Medicine Center at UC San Diego Health System.

Incontinence is the seventh condition, including chronic migraines and underarm sweating, that Botox has been approved to treat since the drug first arrived on the market as a wrinkle reducer in 2002. The outpatient procedure uses a local numbing gel, followed by 15 to 20 injections in different areas of the bladder muscle. “It can really be life changing for someone with severe incontinence issues,” said Nager who also serves as director of Urogynecology and Reconstructive Pelvic Surgery in the Department of Reproductive Medicine at UC San Diego. UC San Diego Health System is currently recruiting for a clinical trial to test Botox injections versus sacral nerve stimulation as incontinence treatment options. Sacral nerve stimulation uses small, electrical impulses to the nerves that control urination. The impulses are generated by a small device surgically placed under the skin. Attached to the device is a thin, electrode-tipped wire that passes under the patient’s skin, carrying impulses to the sacral nerve. The surgery is an outpatient procedure done under local anesthesia. Patients involved in the clinical trial are required to have tried two drugs that previously failed to treat their incontinence issues.

Science Daily
April 3, 2012

Original web page at Science Daily