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Jiang X, Xu Y, Li M, Jiao G, Rong X, Bu F. Antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management for sternal infection after midline sternotomy. J Cardiothorac Surg 2024; 19:289. [PMID: 38745239 PMCID: PMC11092104 DOI: 10.1186/s13019-024-02749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Deep sternal wound infection (DSWI) after midline sternotomy of cardiac surgery is a challenging complication that affects the outcome of surgery. This study aims to assess the clinical effectiveness of the antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management in the treatment of DSWI. METHODS We retrospectively analyzed 5 patients with DSWI who underwent antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps for chest wall reconstruction after sternotomy for cardiac surgery in a tertiary hospital in China from January 2020 to December 2021. The clinical and follow-up data were retrospectively analyzed. RESULTS All patients had no perioperative mortalities, no postoperative complications, 100% wound healing, and an average hospital stay length of 24 days. The follow-up periods were from 6 to 35 months (mean 19.6 months). None of the cases showed wound problems after initial reconstruction using antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps. CONCLUSIONS We report our successful treatment of DSWI, using antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management. The clinical and follow-up results are favorable.
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Affiliation(s)
- Xia Jiang
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Yong Xu
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Mingqiu Li
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Guoqing Jiao
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Xiaosong Rong
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China.
| | - Fanyu Bu
- Department of Chronic Wound, Wuxi Ninth People's Hospital affiliated to Soochow University, No.999 Liangqing Road, Wuxi, Jiang su Province, 214062, China.
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Zaszczyńska A, Kołbuk D, Gradys A, Sajkiewicz P. Development of Poly(methyl methacrylate)/nano-hydroxyapatite (PMMA/nHA) Nanofibers for Tissue Engineering Regeneration Using an Electrospinning Technique. Polymers (Basel) 2024; 16:531. [PMID: 38399909 PMCID: PMC10893281 DOI: 10.3390/polym16040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The study explores the in vitro biocompatibility and osteoconductivity of poly(methyl methacrylate)/nano-hydroxyapatite (PMMA/nHA) composite nanofibrous scaffolds for bone tissue engineering (BTE). Electrospun scaffolds, exhibiting both low and high fiber orientation, were investigated. The inclusion of hydroxyapatite nanoparticles enhances the osteoconductivity of the scaffolds while maintaining the ease of fabrication through electrospinning. SEM analysis confirms the high-quality morphology of the scaffolds, with successful incorporation of nHA evidenced by SEM-EDS and FTIR methods. DSC analysis indicates that nHA addition increases the PMMA glass transition temperature (Tg) and reduces stress relaxation during electrospinning. Furthermore, higher fiber orientation affects PMMA Tg and stress relaxation differently. Biological studies demonstrate the composite material's non-toxicity, excellent osteoblast viability, attachment, spreading, and proliferation. Overall, PMMA/nHA composite scaffolds show promise for BTE applications.
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Affiliation(s)
| | | | | | - Paweł Sajkiewicz
- Laboratory of Polymers & Biomaterials, Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawinskiego 5b St., 02-106 Warsaw, Poland; (A.Z.); (D.K.); (A.G.)
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Zhelev D, Hristov S, Zderic I, Ivanov S, Visscher L, Baltov A, Ribagin S, Stoffel K, Kralinger F, Winkler J, Richards RG, Varga P, Gueorguiev B. Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique-A Biomechanical Cadaveric Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1604. [PMID: 37763723 PMCID: PMC10536689 DOI: 10.3390/medicina59091604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects-weakening the osteosynthesis construct-are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66-92 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25° adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p ≤ 0.019. Cycles to 5° varus deformation of the humerus head fragment-set as a clinically relevant failure criterion-and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications.
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Affiliation(s)
- Daniel Zhelev
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria;
| | - Stoyan Hristov
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria;
| | - Ivan Zderic
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Stoyan Ivanov
- Department of Orthopaedics and Traumatology, Medical University of Varna, 9002 Varna, Bulgaria;
| | - Luke Visscher
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
- School of Medicine, Queensland University of Technology, Brisbane 4000, Australia
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’, 1606 Sofia, Bulgaria;
| | - Simeon Ribagin
- Department of Health Pharmaceutical Care, Medical College, University ‘Prof. Dr. Asen Zlatarov’, 8010 Burgas, Bulgaria;
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland;
| | - Franz Kralinger
- Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Trauma and Sports Department, Ottakring Clinic, Teaching Hospital, Medical University of Vienna, 1160 Vienna, Austria
| | - Jörg Winkler
- Cantonal Hospital Graubuenden, 7000 Chur, Switzerland;
| | - R. Geoff Richards
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Peter Varga
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
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Jordan MC, Hufnagel L, McDonogh M, Paul MM, Schmalzl J, Kupczyk E, Jansen H, Heilig P, Meffert RH, Hoelscher-Doht S. Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques. Front Bioeng Biotechnol 2022; 10:896790. [PMID: 35992345 PMCID: PMC9386452 DOI: 10.3389/fbioe.2022.896790] [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: 03/15/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Treatment usually requires osteosynthesis. However, lack of biomechanical understanding of the ideal fixation technique persists. A beak fracture was simulated in synthetic bones and assigned to five different groups of fixation: A) 6.5-mm partial threaded cannulated screws, B) 4.0-mm partial threaded cannulated screws, C) 5.0-mm headless cannulated compression screws, D) 2.3-mm locking plate, and E) 2.8-mm locking plate. Different traction force levels were applied through an Achilles tendon surrogate in a material-testing machine on all stabilized synthetic bones. Outcome measures were peak-to-peak displacement, total displacement, plastic deformation, stiffness, visual-fracture-line displacement, and mode of implant failure. The 2.3- and 2.8-mm plating groups showed a high drop-out rate at 100 N tension force and failed under higher tension levels of 200 N. The fracture fixation using 4.0-mm partial threaded screws showed a significantly higher repair strength and was able to withhold cyclic loading up to 300 N. The lowest peak-to-peak displacement and the highest load-to-failure and stiffness were provided by fracture fixation using 6.5-mm partial threaded cannulated screws or 5.0-mm headless cannulated compression screws. As anticipated, large 6.5-mm screw diameters provide the best biomechanical fixation. Surprisingly, the 5.0-mm headless cannulated compression screws yield reliable stability despite the absent screw head and washer. When such large screws cannot be applied, 4.0-mm screws also allow reasonable fixation strength. Plate fixation should be implemented with precaution and in combination with a restrictive postoperative motion protocol. Finally, clinical cases about the surgical application and recovery are included.
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Xue N, Ding X, Huang R, Jiang R, Huang H, Pan X, Min W, Chen J, Duan JA, Liu P, Wang Y. Bone Tissue Engineering in the Treatment of Bone Defects. Pharmaceuticals (Basel) 2022; 15:ph15070879. [PMID: 35890177 PMCID: PMC9324138 DOI: 10.3390/ph15070879] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023] Open
Abstract
Bones play an important role in maintaining exercise and protecting organs. Bone defect, as a common orthopedic disease in clinics, can cause tremendous damage with long treatment cycles. Therefore, the treatment of bone defect remains as one of the main challenges in clinical practice. Today, with increased incidence of bone disease in the aging population, demand for bone repair material is high. At present, the method of clinical treatment for bone defects including non-invasive therapy and invasive therapy. Surgical treatment is the most effective way to treat bone defects, such as using bone grafts, Masquelet technique, Ilizarov technique etc. In recent years, the rapid development of tissue engineering technology provides a new treatment strategy for bone repair. This review paper introduces the current situation and challenges of clinical treatment of bone defect repair in detail. The advantages and disadvantages of bone tissue engineering scaffolds are comprehensively discussed from the aspect of material, preparation technology, and function of bone tissue engineering scaffolds. This paper also summarizes the 3D printing technology based on computer technology, aiming at designing personalized artificial scaffolds that can accurately fit bone defects.
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Affiliation(s)
- Nannan Xue
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Xiaofeng Ding
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Rizhong Huang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Ruihan Jiang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Heyan Huang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Xin Pan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Wen Min
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Jun Chen
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Jin-Ao Duan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Pei Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
- Correspondence: (P.L.); (Y.W.); Tel.: +86-(25)-8581-1917 (P.L. & Y.W.)
| | - Yiwei Wang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Concord Repatriation General Hospital, Concord 2137, Australia
- Correspondence: (P.L.); (Y.W.); Tel.: +86-(25)-8581-1917 (P.L. & Y.W.)
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