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Buschmann J, Yamada Y, Schulz-Schönhagen K, Hess SC, Stark WJ, Opelz C, Bürgisser GM, Weder W, Jungraithmayr W. Hybrid nanocomposite as a chest wall graft with improved integration by adipose-derived stem cells. Sci Rep 2019; 9:10910. [PMID: 31358841 PMCID: PMC6662805 DOI: 10.1038/s41598-019-47441-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
Surgery of the chest wall is potentially required to cover large defects after removal of malignant tumours. Usually, inert and non-degradable Gore-Tex serves to replace the missing tissue. However, novel biodegradable materials combined with stem cells are available that stimulate the healing. Based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles (PLGA/aCaP) and pure PLGA, a dual layer biodegradable hybrid nanocomposite was generated. Mouse adipose-derived stem cells were cultered on electrospun disks (ASCs of C57BL/6), and biomechanical tests were performed. The cell-seeded scaffolds were engrafted in C57BL/LY5.1 mice to serve as a chest wall substitute. Cell invasion into the bi-layered material, extent of CD45+ cells, inflammatory response, neo-vascularization and ECM composition were determined at 1 and 2 months post-surgery, respectively. The bi-layered hybrid nanocomposite was stable after a 2-week in vitro culture, in contrast to PLGA/aCaP without a PLGA layer. There was a complete biointegration and good vascularization in vivo. The presence of ASCs attracted more CD45+ cells (hematopoietic origin) compared to cell-free scaffolds. Inflammatory reaction was similar for both groups (±ASCs) at 8 weeks. A bi-layered hybrid nanocomposite fabricated of electrospun PLGA/aCaP and a reinforcing layer of pristine PLGA is an ideal scaffold for chest wall reconstruction. It is stable and allows a proper host tissue integration. If ASCs are seeded, they attract more CD45+ cells, supporting the regeneration process.
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Affiliation(s)
- Johanna Buschmann
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Yoshito Yamada
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Konstantin Schulz-Schönhagen
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Samuel C Hess
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Wendelin J Stark
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Christine Opelz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, University Hospital Rostock, Rostock, Germany
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Schulz-Drost S, Syed J, Luber AM, Carbon RT, Besendörfer M. From pullout-techniques to modular elastic stable chest repair: the evolution of an open technique in the correction of pectus excavatum. J Thorac Dis 2019; 11:2846-2860. [PMID: 31463114 PMCID: PMC6688013 DOI: 10.21037/jtd.2019.07.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/20/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Traditionally open procedures have been replaced by minimally invasive techniques in the correction of pectus excavatum. Efforts to improve the extent of mobilization of the chest wall and its stabilization have led to constant modifications. There is currently no consensus about the best procedure for correction of pectus excavatum. METHODS Based on the contributions of a single institution for the last 60 years, we present the various strategies used for the correction of pectus excavatum and the evolution of operational procedures. These approaches are compared with those performed internationally at similar periods. RESULTS Resections with external extension achieved moderate results and were modified in 1962 to the "Shred" method. The establishment of the "Strut" method in 1963 and, in 1977, its extension with the erection of the lower rib arches significantly improved patient outcomes. The "minimization" of the procedure in 2006 was accompanied by an increase in wound healing disorders and recurrent deformities. Since 2010, elastic stable chest repair (ESCR) has provided lossless mobilization and sternal elevation for healing costosternal pseudarthrosis and allowed correction of complex recurrences with excellent cosmetic-functional results. Strong asymmetric or broad-base deformities can now be stabilized using a modular hybrid technique of transsternal bar and locked plates. CONCLUSIONS ESCR marks the end of the 60-year development of an open procedure and, after loss-free mobilization of the chest wall by elastic-stable biomechanical management, optimizes the possibility of anatomical reconstruction of the chest wall during initial and re-interventions, achieving a permanent, physiologically stable remodeling of the chest wall.
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Affiliation(s)
- Stefan Schulz-Drost
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany
- Department of Trauma and Orthopedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Julia Syed
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Anna-Maria Luber
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roman T. Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Manuel Besendörfer
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
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Schulz-Drost S, Luber AM, Simon K, Schulz-Drost M, Syed J, Carbon RT, Besendörfer M. Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum. J Thorac Dis 2018; 10:5736-5746. [PMID: 30505481 DOI: 10.21037/jtd.2018.09.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Complex and mature funnel chest deformities are traditionally managed with open surgical procedures. Elastic stable chest repair (ESCR) has been used successfully and safely for relapse corrections. Does pure plate osteosynthesis in ESCR allow comparable corrective potency and implant safety as hybrid methods with metal bars? Methods Data from 86 patients with open funnel chest correction between 2011 and 2015 were analyzed in this retrospective study. Exclusion criteria included being under 12 years of age, and having a history of septic wound healing disorder or other malignant diseases. Main groups consisted of ESCR and hybrid techniques, subgroups were primary and recurrence correction. Correction results and follow-up examinations at six and 12 weeks and at 1 year were statistically analyzed. Results A total of 38 ESCR and 48 hybrid methods were analyzed. Bar implantation was required in 77% (recurrence 34%) of patients. All patients received plates with different combinations e.g., longitudinal-sternal, costosternal and costo-sterno-costal. In all groups, follow-up uptake showed a funnel chest correction result at the anatomical level with healthy values according to the Haller index (ESCR 4.36-2.84, hybrid 6.99-2.74, P<0.001). No material dislocations were observed in any subgroup. Conclusions ESCR and hybrid techniques represent promising and safe therapeutic approaches.
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Affiliation(s)
- Stefan Schulz-Drost
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany.,Department of Trauma and Orthopedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Anna Maria Luber
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Kirsten Simon
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Melanie Schulz-Drost
- Department of Medical Controlling and Management, Military Hospital, Berlin, Germany
| | - Julia Syed
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roman T Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Manuel Besendörfer
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
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Krinner S, Langenbach A, Hennig FF, Ekkernkamp A, Schulz-Drost S. [Lesions of the anterior chest wall-significance of additional fractures of the spine]. Unfallchirurg 2018; 121:624-633. [PMID: 30043075 DOI: 10.1007/s00113-018-0529-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fractures of the anterior chest wall are rare among the total number of fractures. They include sternal fractures (SF) and the adjacent cartilaginous structures of the ribs. The accident mechanism can allow conclusions to be drawn about which further accompanying injuries may be present, e.g. rib and spinal fractures. OBJECTIVE The present work is intended to give an overview of injuries of the anterior chest wall. It includes clinical aspects as well as imaging and popular literature. MATERIAL AND METHODS Included are injury constellations of the anterolateral chest wall, in particular of the sternum in combination with injuries of the spinal column in the sense of a sternovertebral injury (SVI). Possible treatment strategies were reviewed and the corresponding advantages and disadvantages are presented. RESULTS In symptomatic fractures of the anterior chest wall, their operative stabilization should be considered in order to restore the stability of the trunk. In addition, rib fractures in direct trauma and spinal injuries in indirect trauma are often included in the treatment. CONCLUSION In the case of injuries of the thoracic trunk, this must always be regarded as a unit and must therefore be clarified in the context of the clinical examination and diagnostic apparatus. The possible accident mechanism can allow conclusions to be drawn about possible injury patterns, e.g. in the sense of SVIs.
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Affiliation(s)
- S Krinner
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - A Langenbach
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - F F Hennig
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - A Ekkernkamp
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warenerstr. 7, 12683, Berlin, Deutschland
| | - S Schulz-Drost
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.,Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warenerstr. 7, 12683, Berlin, Deutschland
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Agrawal N, Zavlin D, Klebuc MJ, Chan EY, Kim MP. Use of sternal plate for pectus excavatum repair in adults leads to minimal postoperative pain. J Surg Case Rep 2018; 2018:rjy045. [PMID: 29942462 PMCID: PMC6007692 DOI: 10.1093/jscr/rjy045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/21/2018] [Indexed: 11/12/2022] Open
Abstract
Pectus excavatum is a chest wall deformity that results in caved-in or sunken appearance of lower half of anterior chest. Surgical treatment is favored when functional or cosmetic concerns arise. We present a case and series of six patients (mean haller index: 4.28) who had repair with minimal pleural disruption and sternal plate. After a broad bilateral inframammary skin incision, the anterior aspect of sternum is identified and incised. Next, the surgeon hyperextends and fixates the bone in its desired position by applying manual dorsal pressure through a small intercostal incision. Superior and inferior fasciocutaneous flaps are raised and then advanced to reconstruct the soft tissue defect. All patients had durable repair of the chest wall abnormalities and they had minimal pain during the postoperative period. No analgesia medication was necessary 1 month post-operatively. This may provide significantly less pain compared to the Nuss or Ravitch procedures to fix Pectus excavatum.
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Affiliation(s)
- Nikhil Agrawal
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
| | - Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
| | - Michael J Klebuc
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
| | - Edward Y Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
| | - Min P Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
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Krinner S, Grupp S, Oppel P, Langenbach A, Hennig FF, Schulz-Drost S. Do low profile implants provide reliable stability in fixing the sternal fractures as a "fourth vertebral column" in sternovertebral injuries? J Thorac Dis 2017; 9:1054-1064. [PMID: 28523160 DOI: 10.21037/jtd.2017.03.37] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Flexion and compression forces to the trunk can cause severe instability of the vertebral column and the anterior chest wall, mostly associated with an unstable fracture of the sternum. In combination, the worst case would be a complete disruption of the trunk. Some authors consider the sternum-rib-complex to be the fourth vertebral column. This study discusses the possibilities to treat instable trunk injuries with sternal fractures concomitant to vertebral spine fractures through anterior sternal plating employing a locked plate osteosynthesis in a low profile design instead of the use of bulky implants. METHODS 11 Patients suffering from at least one fracture of a vertebral body in combination with an unstable sternum fracture were stabilized through a locked plate osteosynthesis in low profile design at the sternum between November 2011 and October 2014. The vertebral spine injury was stabilized as well, if necessary. Patients were followed up with a look at the consolidation of the fractures and the question if any failure of the implants occurred. RESULTS Anterior sternal plating was uneventful in all cases. All Sternal fractures showed sufficient consolidation. No failure of implants has been seen during follow up over two years.. CONCLUSIONS A locked plate osteosynthesis of a sternal fracture in low profile design seem to be an appropriate option for stabilization of the sternum in combined sternovertebral injuries.
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Affiliation(s)
- Sebastian Krinner
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Sina Grupp
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Pascal Oppel
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Andreas Langenbach
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Friedrich F Hennig
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Stefan Schulz-Drost
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.,Department of Pediatric Surgery, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
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