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Kakinoki R, Hara Y, Yoshimoto K, Kaizawa Y, Hashimoto K, Tanaka H, Kobayashi T, Ohtani K, Noguchi T, Ikeguchi R, Akagi M, Goto K. Fabrication of Artificial Nerve Conduits Used in a Long Nerve Gap: Current Reviews and Future Studies. Bioengineering (Basel) 2024; 11:409. [PMID: 38671830 PMCID: PMC11048626 DOI: 10.3390/bioengineering11040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
There are many commercially available artificial nerve conduits, used mostly to repair short gaps in sensory nerves. The stages of nerve regeneration in a nerve conduit are fibrin matrix formation between the nerve stumps joined to the conduit, capillary extension and Schwann cell migration from both nerve stumps, and, finally, axon extension from the proximal nerve stump. Artificial nerves connecting transected nerve stumps with a long interstump gap should be biodegradable, soft and pliable; have the ability to maintain an intrachamber fibrin matrix structure that allows capillary invasion of the tubular lumen, inhibition of scar tissue invasion and leakage of intratubular neurochemical factors from the chamber; and be able to accommodate cells that produce neurochemical factors that promote nerve regeneration. Here, we describe current progress in the development of artificial nerve conduits and the future studies needed to create nerve conduits, the nerve regeneration of which is compatible with that of an autologous nerve graft transplanted over a long nerve gap.
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Affiliation(s)
- Ryosuke Kakinoki
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Yukiko Hara
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Koichi Yoshimoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopedic Surgery, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka City 553-0003, Japan
| | - Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Hiroki Tanaka
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Takaya Kobayashi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Kazuhiro Ohtani
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Takashi Noguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shougoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shougoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Koji Goto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
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Kaizawa Y, Ohta S. Marked progression of scapholunate advanced collapse after endoscopic carpal tunnel release: a case report. J Hand Surg Eur Vol 2023; 48:154-156. [PMID: 36324197 DOI: 10.1177/17531934221132754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Souichi Ohta
- Kansai Electric Power Hospital, Fukushima-ku, Osaka, Japan
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Oda H, Kaizawa Y, Franklin A, Sanchez Rangel U, Storaci H, Min JG, Wang Z, Abrams GD, Chang J, Fox PM. Assessment of a Synergistic Effect of Platelet-Rich Plasma and Stem Cell-Seeded Hydrogel for Healing of Rat Chronic Rotator Cuff Injuries. Cell Transplant 2023; 32:9636897231190174. [PMID: 37592455 PMCID: PMC10467370 DOI: 10.1177/09636897231190174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
Outcomes after repair of chronic rotator cuff injuries remain suboptimal. Type-1 collagen-rich tendon hydrogel was previously reported to improve healing in a rat chronic rotator cuff injury model. Stem cell seeding of the tendon hydrogel improved bone quality in the same model. This study aimed to examine whether there was a synergistic and dose-dependent effect of platelet-rich plasma (PRP) on tendon-bone interface healing by combining PRP with stem cell-seeded tendon hydrogel. Human cadaveric tendons were processed into a hydrogel. PRP was prepared at two different platelet concentrations: an initial concentration (initial PRP group) and a higher concentration (concentrated PRP group). Tendon hydrogel was mixed with adipose-derived stem cells and one of the platelet concentrations. Methylcellulose, as opposed to saline, was used as a negative control due to comparable viscosity. The supraspinatus tendon was detached bilaterally in 33 Sprague-Dawley rats (66 shoulders). Eight weeks later, each detached tendon was repaired, and a hydrogel mixture or control was injected at the repair site. Eight weeks after repair, shoulder samples were harvested and assigned for biomechanical testing (n = 42 shoulders) or a combination of bone morphological and histological assessment (n = 24 shoulders). Biomechanical testing showed significantly higher failure load and stiffness in the concentrated PRP group than in control. Yield load in the initial and concentrated PRP groups were significantly higher than that in the control. There were no statistically significant differences between the initial and concentrated PRP groups. The addition of the highly concentrated PRP to stem cells-seeded tendon hydrogel improved healing biomechanically after chronic rotator cuff injury in rats compared to control. However, synergistic and dose-dependent effects were not seen.
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Affiliation(s)
- Hiroki Oda
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Yukitoshi Kaizawa
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Austin Franklin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Uriel Sanchez Rangel
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Hunter Storaci
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - Jung Gi Min
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Zhen Wang
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Geoffrey D. Abrams
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - James Chang
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paige M. Fox
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Oda H, Kaizawa Y, Franklin A, Rangel US, Min JG, Akerman J, Storaci H, Wang Z, Abrams GD, Chang J, Fox PM. Biomechanical, Histologic, and Micro-Computed Tomography Characterization of Partial-Width Full-Thickness Supraspinatus Tendon Injury in Rats. J Hand Surg Am 2022:S0363-5023(22)00510-X. [PMID: 36280554 DOI: 10.1016/j.jhsa.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/08/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Partial rotator cuff tears can cause shoulder pain and dysfunction and are more common than complete tears. However, few studies examine partial injuries in small animals and, therefore a robust, clinically relevant model may be lacking. This study aimed to fully characterize the established rat model of partial rotator cuff injury over time and determine if it models human partial rotator cuff tears. METHODS We created a full-thickness, partial-width injury at the supraspinatus tendon-bone interface bilaterally in 31 Sprague-Dawley rats. Rats were euthanized immediately, and at 2-, 3-, 4-, and 8-weeks after surgery. Fourteen intact shoulders were used as controls. Samples were assessed biomechanically, histologically, and morphologically. RESULTS Biomechanically, load to failure in controls and 8 weeks after injury was significantly greater than immediately and 3 weeks after injury. Load to failure at 8 weeks was comparable to control. However, the locations of failure were different between intact shoulders and partially injured samples. Bone mineral density at 8 weeks was significantly greater than that at 2 and 3 weeks. Although no animals demonstrated propagation to complete tear and the injury site remodeled histologically, the appearance at 8 weeks was not identical to that in the controls. CONCLUSIONS The biomechanical properties and bone quality decreased after the injury and was restored gradually over time with full restoration by 8 weeks after injury. However, the findings were not equivalent to the intact shoulder. This study demonstrated the limitations of the current model in its application to long-term outcome studies, and the need for better models that can be used to assess chronic partial rotator cuff injuries. CLINICAL RELEVANCE There is no small animal model that mimics human chronic partial rotator cuff tears, which limits our ability to improve care for this common condition.
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Affiliation(s)
- Hiroki Oda
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Yukitoshi Kaizawa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Austin Franklin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Uriel Sanchez Rangel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jung Gi Min
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jack Akerman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Hunter Storaci
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Zhen Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Geoffrey D Abrams
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Ohta S, Ikeguchi R, Noguchi T, Kaizawa Y, Matsuda S. Intractable Fractures of the Bilateral Proximal Ulnae After 8 Years of Zoledronate Treatment for Breast Cancer Bone Metastasis. J Hand Surg Am 2022; 47:393.e1-393.e7. [PMID: 33846026 DOI: 10.1016/j.jhsa.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/06/2020] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
Long-term administration of bisphosphonates strongly suppresses osteoclastic bone resorption and rarely causes atypical fractures. This report presents a case of bilateral atypical ulnar fractures, following an 8-year course of zoledronate to treat breast cancer bone metastasis. Nonsurgical treatment for the left ulnar fracture failed, in spite of minimal displacement with callus formation at initial presentation. After failure of plate fixation with a pedicled vascularized bone graft, removal of osteosclerotic lesions and plate fixation with corticocancellous iliac bone graft resulted in bone healing, although the healing process took 1.5 years. Plate fixation for the contralateral fractured ulna was unsuccessful.
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Affiliation(s)
- Souichi Ohta
- Department of Spine, Hand, and Orthopaedic Surgery, Kansai Electric Power Hospital, Osaka.
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukitoshi Kaizawa
- Department of Spine, Hand, and Orthopaedic Surgery, Kansai Electric Power Hospital, Osaka
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, School of Medicine, Kyoto University, Kyoto, Japan
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Franklin A, Gi Min J, Oda H, Kaizawa Y, Leyden J, Wang Z, Chang J, Fox PM. Homing of Adipose-Derived Stem Cells to a Tendon-Derived Hydrogel: A Potential Mechanism for Improved Tendon-Bone Interface and Tendon Healing. J Hand Surg Am 2020; 45:1180.e1-1180.e12. [PMID: 32605739 DOI: 10.1016/j.jhsa.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/29/2020] [Accepted: 05/07/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Tendons are difficult to heal owing to their hypocellularity and hypovascularity. Our laboratory has developed a tendon-derived hydrogel (tHG) that significantly improves tendon healing in an animal model. We hypothesized that a potential mechanism for improved healing with tHG is through the attraction of systemic stem cells. METHODS Homing of systemic adipose-derived stem cells (ADSCs) to tendon injuries was assessed with acute and chronic injury models. Injury sites were treated with saline or tHG, and animals given a tail vein injection (TVI) of labeled ADSCs 1 week after treatment. One week following TVI, rats were harvested for histology. To further evaluate a potential difference in homing to tHG, a subcutaneous injection (SQI) model was used. Rats were treated with an SQI of saline, silicone, ADSCs in media, tHG, tHG + fibroblasts (FBs), or tHG + ADSCs on day 0. One week after SQI, rats underwent TVI with labeled ADSCs. Samples were harvested 2 or 3 weeks after SQI for analysis. Flow cytometry confirmed homing in the SQI model. RESULTS Systemically delivered ADSCs homed to both acute tendon and chronic tendon-bone interface (TBI) injury sites. Despite their presence at the injury site, there was no difference in the number of macrophages, amount of cell proliferation, or angiogenesis 1 week after stem cell delivery. In an SQI model, ADSCs homed to tHG. There was no difference in the number of ADSCs homing to tHG alone versus tHG + ADSCs. However, there was an increase in the number of living cells, general immune cells, and T-cells present at tHG + ADSC versus tHG alone. CONCLUSIONS The ADSCs home to tendon injury sites and tHG. We believe the attraction of additional systemic ADSCs is one mechanism for improved tendon and TBI healing with tHG. CLINICAL RELEVANCE Treatment of tendon and TBI injuries with tHG can augment healing via homing of systemic stem cells.
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Affiliation(s)
- Austin Franklin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jung Gi Min
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Hiroki Oda
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Yukitoshi Kaizawa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jacinta Leyden
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Zhen Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Oda H, Beker L, Kaizawa Y, Franklin A, Min JG, Leyden J, Wang Z, Chang J, Bao Z, Fox PM. A Novel Technology for Free Flap Monitoring: Pilot Study of a Wireless, Biodegradable Sensor. J Reconstr Microsurg 2019; 36:182-190. [PMID: 31675757 DOI: 10.1055/s-0039-1700539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Accurate monitoring of free flap perfusion after complex reconstruction is critical for early recognition of flap compromise. Surgeons use a variety of subjective and objective measures to evaluate flap perfusion postoperatively. However, these measures have some limitations. We have developed a wireless, biodegradable, and flexible sensor that can be applied to real-time postoperative free flap monitoring. Here we assess the biocompatibility and function of our novel sensor. METHODS Seven Sprague-Dawley (SD) rats were used for biocompatibility studies. The sensor was implanted around the femoral artery near the inguinal ligament on one leg (implant side) and sham surgery was performed on the contralateral leg (control side). At 6 and 12 weeks, samples were harvested to assess the inflammation within and around the implant and artery. Two animals were used to assess sensor function. Sensor function was evaluated at implantation and 7 days after the implantation. Signal changes after venous occlusion were also assessed in an epigastric artery island flap model. RESULTS In biocompatibility studies, the diameter of the arterial lumen and intima thickness in the implant group were not significantly different than the control group at the 12-week time point. The number of CD-68 positive cells that infiltrated into the soft tissue, surrounding the femoral artery, was also not significantly different between groups at the 12-week time point. For sensor function, accurate signaling could be recorded at implantation and 7 days later. A change in arterial signal was noted immediately after venous occlusion in a flap model. CONCLUSION The novel wireless, biodegradable sensor presented here is biocompatible and capable of detecting arterial blood flow and venous occlusion with high sensitivity. This promising new technology could combat the complications of wired sensors, while improving the survival rate of flaps with vessel compromise due to its responsive nature.
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Affiliation(s)
- Hiroki Oda
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Levent Beker
- Department of Chemical Engineering, Stanford University, Stanford, California
| | - Yukitoshi Kaizawa
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Austin Franklin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jung Gi Min
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jacinta Leyden
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Zhen Wang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - James Chang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Zhenan Bao
- Department of Chemical Engineering, Stanford University, Stanford, California
| | - Paige M Fox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Kaizawa Y, Leyden J, Behn AW, Tulu US, Franklin A, Wang Z, Abrams G, Chang J, Fox PM. Human Tendon-Derived Collagen Hydrogel Significantly Improves Biomechanical Properties of the Tendon-Bone Interface in a Chronic Rotator Cuff Injury Model. J Hand Surg Am 2019; 44:899.e1-899.e11. [PMID: 30685142 DOI: 10.1016/j.jhsa.2018.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/10/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Poor healing of the tendon-bone interface (TBI) after rotator cuff (RTC) tears leads to high rates of recurrent tear following repair. Previously, we demonstrated that an injectable, thermoresponsive, type I collagen-rich, decellularized human tendon-derived hydrogel (tHG) improved healing in an acute rat Achilles tendon injury model. The purpose of this study was to investigate whether tHG enhances the biomechanical properties of the regenerated TBI in a rat model of chronic RTC injury and repair. METHODS Tendon hydrogel was prepared from chemically decellularized human cadaveric flexor tendons. Eight weeks after bilateral resection of supraspinatus tendons, repair of both shoulders was performed. One shoulder was treated with a transosseous suture (control group) and the other was treated with a transosseous suture plus tHG injection at the repair site (tHG group). Eight weeks after repair, the TBIs were evaluated biomechanically, histologically, and via micro-computed tomography (CT). RESULTS Biomechanical testing revealed a larger load to failure, higher stiffness, higher energy to failure, larger strain at failure, and higher toughness in the tHG group versus control. The area of new cartilage formation was significantly larger in the tHG group. Micro-CT revealed no significant difference between groups in bone morphometry at the supraspinatus tendon insertion, although the tHG group was superior to the control. CONCLUSIONS Injection of tHG at the RTC repair site enhanced biomechanical properties and increased fibrocartilage formation at the TBI in a chronic injury model. CLINICAL RELEVANCE Treatment of chronic RTC injuries with tHG at the time of surgical treatment may improve outcomes after surgical repair.
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Affiliation(s)
- Yukitoshi Kaizawa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jacinta Leyden
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - U Serdar Tulu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Austin Franklin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Zhen Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Geoffrey Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA; Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Kakinoki R, Duncan SFM, Ikeguchi R, Ohta S, Nankaku M, Sakai H, Noguchi T, Kaizawa Y, Akagi M. Motor and Sensory Cortical Changes after Contralateral Cervical Seventh Nerve Root (CC7) Transfer in Patients with Brachial Plexus Injuries. J Hand Surg Asian Pac Vol 2019; 22:138-149. [PMID: 28506157 DOI: 10.1142/s0218810417500162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous animal studies demonstrated that the sensory and motor functions in ipsilesional upper limbs that had been reconstructed by CC7 transfer eventually associated with the contralesional brain cortices that had originally mediated the functions of the ipsilesional upper limbs before brachial plexus injury (BPI). Our hypothesis was that the same findings would be seen in humans. METHODS Four patients with total BPI treated with CC7 transfer were included. Changes in the locations of the activated areas in the primary motor (M1) and somatosensory (S1) cortices corresponding to the motor outputs to and sensory inputs from the ipsilesional limbs were investigated using functional near-infrared spectroscopy (fNIRS) 2-3 years and 6-7 years after surgery. RESULTS One patient was excluded from the evaluation of motor function after CC7 transfer. The motor and sensory functions of the ipsilesional upper limb in all patients were still controlled by the ipsilesional brain hemisphere 2-3 years after CC7 transfer. The reconstructed motions of the ipsilesional upper limbs correlated with the contralesional M1 in one patient and the bilateral M1s in another patient (both of whom demonstrated good motor recovery in the ipsilesional upper limbs) and with the ipsilesional M1 in a third patient with poor motor recovery in the ipsilesional upper limb. Sensory stimulation of the ipsilesional hands 6-7 years after CC7 transfer activated the contralesional S1 in two patients who achieved good sensory recovery in the ipsilesional hands but activated the ipsilesional S1 in the other two patients with poor sensory recovery of the ipsilesional hands. CONCLUSIONS Transhemispheric transposition of the activated brain cortices associated with the recovery of motor and sensory functions of the ipsilesional upper limbs was seen in patients with CC7 transfer as has been reported for animal models of CC7 transfer.
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Affiliation(s)
- Ryosuke Kakinoki
- * Department of Orthopaedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Scott F M Duncan
- † Department of Orthopaedic Surgery, Boston University, Boston, MA
| | - Ryosuke Ikeguchi
- ‡ Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,§ Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Souichi Ohta
- ‡ Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Nankaku
- § Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Sakai
- ∥ Deaprtment of the Occupational Therapy, Nagoya University, School of Health Sciences, Nagoya, Japan
| | - Takashi Noguchi
- † Department of Orthopaedic Surgery, Boston University, Boston, MA
| | - Yukitoshi Kaizawa
- ‡ Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Akagi
- * Department of Orthopaedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
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10
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Kaizawa Y, Franklin A, Leyden J, Behn AW, Tulu US, Sotelo Leon D, Wang Z, Abrams GD, Chang J, Fox PM. Augmentation of chronic rotator cuff healing using adipose-derived stem cell-seeded human tendon-derived hydrogel. J Orthop Res 2019; 37:877-886. [PMID: 30747435 DOI: 10.1002/jor.24250] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 01/24/2019] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RTC) repair outcomes are unsatisfactory due to the poor healing capacity of the tendon bone interface (TBI). In our preceding study, tendon hydrogel (tHG), which is a type I collagen rich gel derived from human tendons, improved biomechanical properties of the TBI in a rat chronic RTC injury model. Here we investigated whether adipose-derived stem cell (ASC)-seeded tHG injection at the repair site would further improve RTC healing. Rats underwent bilateral supraspinatus tendon detachment. Eight weeks later injured supraspinatus tendons were repaired with one of four treatments. In the control group, standard transosseous suture repair was performed. In the ASC, tHG, tHGASC groups, ASC in media, tHG, and ASC-seeded tHG were injected at repair site after transosseous suture repair, respectively. Eight weeks after repair, the TBI was evaluated biomechanically, histologically, and via micro CT. Implanted ASCs were detected in ASC and tHGASC groups 7 weeks after implantation. ACS implantation improved bone morphometry at the supraspinatus insertion on the humerus. Injection of tHG improved biomechanical properties of the repaired TBI. RTC healing in tHGASC group was significantly better than control but statistically equivalent to the tHG group based on biomechanical properties, fibrocartilage area at the TBI, and bone morphometry at the supraspinatus insertion. In a rat RTC chronic injury model, no biomechanical advantage was gained with ASC augmentation of tHG. Clinical Significance: Tendon hydrogel augmentation with adipose derived stem cells does not significantly improve TBI healing over tHG alone in a chronic rotator cuff injury model. © 2019 Orthopaedic Research Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Yukitoshi Kaizawa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
| | - Austin Franklin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
| | - Jacinta Leyden
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, California, 94305
| | - Ustun S Tulu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304
| | - Daniel Sotelo Leon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
| | - Zhen Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, California, 94305
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd., Suite 400, Palo Alto, California, 94304.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, California, 94304
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11
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Boutry CM, Beker L, Kaizawa Y, Vassos C, Tran H, Hinckley AC, Pfattner R, Niu S, Li J, Claverie J, Wang Z, Chang J, Fox PM, Bao Z. Biodegradable and flexible arterial-pulse sensor for the wireless monitoring of blood flow. Nat Biomed Eng 2019; 3:47-57. [DOI: 10.1038/s41551-018-0336-5] [Citation(s) in RCA: 371] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
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12
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Oda H, Ikeguchi R, Aoyama T, Ohta S, Noguchi T, Kaizawa Y, Yurie H, Takeuchi H, Mitsuzawa S, Yamamoto K, Matsuda S. Relative antigenicity of components in vascularized composite allotransplants: An experimental study of microRNAs expression in rat hind limb transplantation model. Microsurgery 2018; 39:340-348. [DOI: 10.1002/micr.30408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Hiroki Oda
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery; Tango Central Hospital; Kyotango Japan
| | - Yukitoshi Kaizawa
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Hirofumi Yurie
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Hisataka Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Koji Yamamoto
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences; Doshisha University; Kyotango Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine; Kyoto University; Kyoto Japan
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13
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Oda H, Ohta S, Ikeguchi R, Noguchi T, Kaizawa Y, Yurie H, Takeuchi H, Mitsuzawa S, Matsuda S. Pretreatment of nerve grafts with resveratrol improves axonal regeneration following replantation surgery for nerve root avulsion injury in rats. Restor Neurol Neurosci 2018; 36:647-658. [PMID: 30056441 DOI: 10.3233/rnn-180844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Replantation of the avulsed nerve root has been proposed for the treatment of severe brachial plexus injury for several decades. However, due to the complexity of the technique and limited functional improvement, practical applications are yet to be implemented. OBJECTIVE In the present study, we investigated the effect of pretreatment with resveratrol on nerve autografts used for replantation surgery in a rat model of nerve root avulsion. METHODS Resveratrol pretreatment was performed using an explant culture technique. Two surgical procedures were performed. During the first surgery, Sprague-Dawley rats were subjected to left C6 nerve root avulsion, and nerves were harvested for autografting. The harvested grafts were explant-cultured for 1 week. A second procedure was performed to replant the C6 nerve root using the explant-cultured nerve graft 1 week after the first procedure. Histological and immunohistochemical analyses were performed 8 weeks after the second procedure. We first compared findings between explant-cultured nerve grafts and fresh nerve grafts, following which we compared findings between explant-cultured grafts pretreated with and without resveratrol. Changes induced within nerve grafts by 1 week of explant culture with or without resveratrol were investigated in vitro. RESULTS There was no significant difference in outcomes between 1 week-explant-cultured and fresh nerve grafts. Addition of resveratrol to the explant culture medium resulted in a significant increase in the number and myelin thickness of regenerated axons, and in the number of regenerating motor neurons in the C6 spinal cord segment. In vitro analyses revealed that nerve grafts pretreated with resveratrol exhibited significant increases in glial cell line-derived neurotrophic factor (GDNF) expression and the number of dedifferentiated Schwann cells. CONCLUSIONS Resveratrol may promote axonal regeneration following replantation surgery for the treatment of nerve root avulsion injury; however, further studies are required to verify these findings in humans.
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Affiliation(s)
- Hiroki Oda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Tango Central Hospital, Sugitani, Mineyama-cho, Kyotango, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Hirofumi Yurie
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Hisataka Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-Cho, Sakyo-ku, Japan
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Oda H, Ikeguchi R, Aoyama T, Ohta S, Noguchi T, Kaizawa Y, Yurie H, Takeuchi H, Yamamoto K, Matsuda S. MicroRNAs are potential objective and early biomarkers for acute rejection of transplanted limbs in a rat model. Microsurgery 2017; 37:930-936. [DOI: 10.1002/micr.30236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 06/29/2017] [Accepted: 08/25/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Hiroki Oda
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Tomoki Aoyama
- Department of Physical TherapyHuman Health Sciences, Graduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Souichi Ohta
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Takashi Noguchi
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Yukitoshi Kaizawa
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Hirofumi Yurie
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Hisataka Takeuchi
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
| | - Koji Yamamoto
- Department of Biomedical Engineering, Faculty of Life and Medical SciencesDoshisha UniversityKyotanabe, Kyoto Japan
| | - Shuichi Matsuda
- Department of Orthopaedic SurgeryGraduate School of Medicine, Kyoto UniversityKyoto Japan
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Yurie H, Ikeguchi R, Aoyama T, Kaizawa Y, Tajino J, Ito A, Ohta S, Oda H, Takeuchi H, Akieda S, Tsuji M, Nakayama K, Matsuda S. The efficacy of a scaffold-free Bio 3D conduit developed from human fibroblasts on peripheral nerve regeneration in a rat sciatic nerve model. PLoS One 2017; 12:e0171448. [PMID: 28192527 PMCID: PMC5305253 DOI: 10.1371/journal.pone.0171448] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/02/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although autologous nerve grafting is the gold standard treatment of peripheral nerve injuries, several alternative methods have been developed, including nerve conduits that use supportive cells. However, the seeding efficacy and viability of supportive cells injected in nerve grafts remain unclear. Here, we focused on a novel completely biological, tissue-engineered, scaffold-free conduit. METHODS We developed six scaffold-free conduits from human normal dermal fibroblasts using a Bio 3D Printer. Twelve adult male rats with immune deficiency underwent mid-thigh-level transection of the right sciatic nerve. The resulting 5-mm nerve gap was bridged using 8-mm Bio 3D conduits (Bio 3D group, n = 6) and silicone tube (silicone group, n = 6). Several assessments were conducted to examine nerve regeneration eight weeks post-surgery. RESULTS Kinematic analysis revealed that the toe angle to the metatarsal bone at the final segment of the swing phase was significantly higher in the Bio 3D group than the silicone group (-35.78 ± 10.68 versus -62.48 ± 6.15, respectively; p < 0.01). Electrophysiological studies revealed significantly higher compound muscle action potential in the Bio 3D group than the silicone group (53.60 ± 26.36% versus 2.93 ± 1.84%; p < 0.01). Histological and morphological studies revealed neural cell expression in all regions of the regenerated nerves and the presence of many well-myelinated axons in the Bio 3D group. The wet muscle weight of the tibialis anterior muscle was significantly higher in the Bio 3D group than the silicone group (0.544 ± 0.063 versus 0.396 ± 0.031, respectively; p < 0.01). CONCLUSIONS We confirmed that scaffold-free Bio 3D conduits composed entirely of fibroblast cells promote nerve regeneration in a rat sciatic nerve model.
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Affiliation(s)
- Hirofumi Yurie
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopaedic Surgery, Iseikai Yawata Chuo Hospital, Kyoto, Japan
| | - Junichi Tajino
- Department of Physical Therapy, Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Ito
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Oda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisataka Takeuchi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering Faculty of Medicine, Saga University, Saga, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Ikeguchi R, Kakinoki R, Ohta S, Oda H, Yurie H, Kaizawa Y, Mitsui H, Aoyama T, Toguchida J, Matsuda S. Recipient bone marrow-derived stromal cells prolong graft survival in a rat hind limb allotransplantation model. Microsurgery 2016; 37:632-640. [PMID: 27859595 DOI: 10.1002/micr.30128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/02/2016] [Accepted: 10/27/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recent studies have indicated that bone marrow-derived stromal cells (BMSCs) have immunomodulatory properties that suppress the T cell responses that cause graft rejection. The purpose of this study is to evaluate the effect of recipient BMSCs intravenous infusion for immunomodulation in a rat vascularized composite allotransplantation model. METHODS A total of nine Wistar (WIS) rats and thirty Lewis (LEW) rats were used. BMSCs were harvested from three LEW rats. Twenty-four LEW rats were used as recipients and divided randomly into four groups: BMSC group, FK group, UT group, and Iso group. In the BMSC group, orthotopic rat hind limb transplantation was performed between WIS donor and LEW recipient rats. Recipient rats were injected intravenously with 2 × 106 recipient BMSCs on day 6, and with 0.2 mg/kg/day tacrolimus administered over 7 days (n = 6). In the FK group, recipient rats were treated with tacrolimus alone (n = 6). Rats in the UT group received no immunosuppressive treatment (n = 6). In the Iso group, transplantation was performed from three LEW donor rats to six LEW recipient rats without any immunosuppressive treatment (n = 6). Graft survival was assessed by daily inspection and histology. The immunological reactions of recipients were also evaluated. RESULTS The graft survival of recipient rats in the BMSC group (24.5 days) was significantly prolonged in comparison with that of the FK group (18 days) (P < .01). Cytokine expression analysis of the skin of grafted limbs showed that BMSCs treatment significantly decreased IFN-γ mRNA expression of the BMSC group (0.138 ± 0.045) in comparison with that of the FK group (1.049 ± 0.167) (P = .0001). Recipient rats in the BMSC group had significantly reduced serum IFN-γ cytokine levels (1.571 ± 0.779 pg/ml) in comparison with that of the FK group (7.059 ± 1.522 pg/ml) (P = .001). In in vitro study, BMSCs induce T cell hyporesponsiveness in a mixed lymphocyte reaction. CONCLUSION BMSCs induce T cell hyporesponsiveness and prolong graft survival in the rat vascularized composite allotransplantation model. BMSCs exhibit immunomodulatory properties against acute rejection that can be realized without the need for significant recipient immunosuppression.
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Affiliation(s)
- Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Kakinoki
- Department of Orthopaedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Oda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirofumi Yurie
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroto Mitsui
- Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan
| | - Tomoki Aoyama
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kaizawa Y, Kakinoki R, Ikeguchi R, Ohta S, Noguchi T, Takeuchi H, Oda H, Yurie H, Matsuda S. A Nerve Conduit Containing a Vascular Bundle and Implanted With Bone Marrow Stromal Cells and Decellularized Allogenic Nerve Matrix. Cell Transplant 2016; 26:215-228. [PMID: 27657936 DOI: 10.3727/096368916x692951] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cells, scaffolds, growth factors, and vascularity are essential for nerve regeneration. Previously, we reported that the insertion of a vascular bundle and the implantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) into a nerve conduit promoted peripheral nerve regeneration. In this study, the efficacy of nerve conduits containing a vascular bundle, BM-MSCs, and thermally decellularized allogenic nerve matrix (DANM) was investigated using a rat sciatic nerve model with a 20-mm defect. Lewis rats were used as the sciatic nerve model and for the preparation of BM-MSCs, and Dark Agouti rats were used for the preparation of the DANM. The revascularization and the immunogenicity of the DANM were investigated histologically. The regeneration of nerves through nerve conduits containing vessels, BM-MSCs, and DANM (VBD group) was evaluated based on electrophysiological, morphometric, and reinnervated muscle weight measurements and compared with that of vessel-containing conduits that were implanted with BM-MSCs (VB group). The DANM that was implanted into vessel-containing tubes (VCTs) was revascularized by neovascular vessels that originated from the inserted vascular bundle 5-7 days after surgery. The number of CD8+ cells found in the DANM in the VCT was significantly smaller than that detected in the untreated allogenic nerve segment. The regenerated nerve in the VBD group was significantly superior to that in the VB group with regard to the amplitude of the compound muscle action potential detected in the pedal adductor muscle; the number, diameter, and myelin thickness of the myelinated axons; and the tibialis anterior muscle weight at 12 and 24 weeks. The additional implantation of the DANM into the BM-MSC-implanted VCT optimized the axonal regeneration through the conduit. Nerve conduits constructed with vascularity, cells, and scaffolds could be an effective strategy for the treatment of peripheral nerve injuries with significant segmental defects.
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Ohta S, Ikeguchi R, Noguchi T, Kaizawa Y, Oda H, Yurie H, Matsuda S. Percutaneous Fixation for Scaphoid Nonunion with Bone Grafting Through the Distal Insertion Hole of a Fully Threaded Headless Screw. J Hand Surg Asian Pac Vol 2016; 21:357-63. [PMID: 27595954 DOI: 10.1142/s242483551650034x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Percutaneous scaphoid screw fixation is a popular treatment for acute scaphoid fractures with no or minimal displacement. For treating scaphoid nonunions, however, open reduction and internal fixation with bone grafting is still the most popular treatment. Percutaneous fixation with bone grafting through the screw insertion hole has received little attention, although it minimizes damage to the surrounding tissues. We report excellent results of six scaphoid nonunions treated by retrograde percutaneous fixation with curettage and bone grafting through the distal insertion hole of a fully threaded headless screw. METHODS Six scaphoid nonunions with substantial bone loss were treated, including one revision case. All nonunions were located at the middle third of the scaphoid. The mean patient age at operation was 26 years, and the mean interval between fracture and surgery was 7 months. In the revision case, the interval between the primary and revision surgery was 6 months. In one case, curettage alone was performed before retrograde insertion of the headless screw. In the other cases including the revision, curettage and bone grafting with a bone biopsy needle was required through a distal insertion hole. RESULTS The mean follow-up was 11.3 months. Radiologically, union was achieved at averaged 12 weeks postoperatively. At the final follow-up, there was significant improvement in the wrist extension range of movement (from 65.8° to 80.8°) and grip strength (from 69.5% to 93.0% of the unaffected side). Five patients were free of pain, and one experienced mild pain only during heavy manual labor. The mean VAS, DASH, and Cooney wrist scores were 0.3, 1 and 99, respectively. All patients returned to their work or athletic activities. CONCLUSIONS Retrograde percutaneous fixation with bone grafting through the distal insertion hole of a fully threaded headless screw is a promising option for surgical treatment of scaphoid nonunions.
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Affiliation(s)
- Souichi Ohta
- * Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- * Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- † Department of Orthopaedic Surgery, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Yukitoshi Kaizawa
- ‡ Department of Orthopaedic Surgery, Yawata Central Hosipital, Kyoto, Japan
| | - Hiroki Oda
- * Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Hirofumi Yurie
- * Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- * Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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Noguchi T, Ohta S, Kakinoki R, Ikeguchi R, Kaizawa Y, Oda H, Matsuda S. The neuroprotective effect of erythropoietin on spinal motor neurons after nerve root avulsion injury in rats. Restor Neurol Neurosci 2015; 33:461-70. [DOI: 10.3233/rnn-140481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Takashi Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Kakinoki
- Department of Orthopaedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Oda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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20
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Kaizawa Y, Kakinoki R, Ikeguchi R, Ohta S, Noguchi T, Oda H, Matsuda S. Bridging a 30 mm defect in the canine ulnar nerve using vessel-containing conduits with implantation of bone marrow stromal cells. Microsurgery 2015; 36:316-24. [PMID: 25773965 DOI: 10.1002/micr.22391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 01/31/2015] [Accepted: 02/13/2015] [Indexed: 01/01/2023]
Abstract
Previously, we showed that undifferentiated bone marrow stromal cell (uBMSC) implantation and vessel insertion into a nerve conduit facilitated peripheral nerve regeneration in a rodent model. In this study, we investigated the efficacy of the uBMSC-laden vessel-containing conduit in repair of segmental nerve defects, using a canine model. Eight beagle dogs were used in this study. Thirty-millimeter ulnar nerve defects were repaired with the conduits (right forelimbs, n = 8) or autografts (left forelimbs, n = 7). In the conduit group, the ulnar artery was inserted into the l-lactide/ε-caprolactone tube, which was filled with autologous uBMSCs obtained from the ilium. In the autograft group, the reversed nerve segments were sutured in situ. At 8 weeks, one dog with only nerve repair with the conduit was sacrificed and the regenerated nerve in the conduit underwent immunohistochemistry for investigation of the differentiation capability of the implanted uBMSCs. In the remaining seven dogs, the repaired nerves underwent electrophysiological examination at 12 and 24 weeks and morphometric measurements at 24 weeks. The wet weight of hypothenar muscles was measured at 24 weeks. At 8 weeks, almost 35% of the implanted uBMSCs expressed glial markers. At 12 weeks, amplitude (0.4 ± 0.4mV) and conduction velocity (18.9 ± 14.3m/s) were significantly lower in the conduit group than in the autograft group (3.2 ± 2.5 mV, 34.9 ± 12.1 m/s, P < 0.05). Although the nerve regeneration in the conduit group was inferior when compared with the autograft group at 24 weeks, there were no significant differences between both groups, regarding amplitude (10.9 ± 7.3 vs. 25.3 ± 20.1 mV; P = 0.11), conduction velocity (23.5 ± 8.7 vs 31.6 ± 20.0m/s; P = 0.35), myelinated axon number (7032 ± 4188 vs 7165 ± 1814; P = 0.94), diameter (1.73 ± 0.31 vs 2.09 ± 0.39μm; P = 0.09), or muscle weight (1.02 ± 0.40 vs 1.19 ± 0.26g; P = 0.36). In conclusion, this study showed that vessel-containing tubes with uBMSC implantation may be an option for treatment of peripheral nerve injuries. However, further investigations are needed. © 2015 Wiley Periodicals, Inc. Microsurgery 36:316-324, 2016.
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Affiliation(s)
- Yukitoshi Kaizawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan
| | - Ryosuke Kakinoki
- Department of Orthopaedic Surgery, Faculty of Medicine, Kindai University, Higashiosaka, Osaka Prefecture, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan
| | - Hiroki Oda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto Prefecture, Japan
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Ohta S, Kakinoki R, Noguchi T, Kaizawa Y, Matsuda S. Reconstruction of active elbow flexion in patients with radial ray deficiency: report of two cases. J Shoulder Elbow Surg 2014; 23:e313-e317. [PMID: 25441570 DOI: 10.1016/j.jse.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 08/05/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Souichi Ohta
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan.
| | - Ryosuke Kakinoki
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | | | - Syuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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Noguchi T, Ohta S, Kakinoki R, Kaizawa Y, Matsuda S. A new cervical nerve root avulsion model using a posterior extra-vertebral approach in rats. J Brachial Plex Peripher Nerve Inj 2013; 8:8. [PMID: 24020460 PMCID: PMC3848685 DOI: 10.1186/1749-7221-8-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/04/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The nerve root avulsion injury causes decrease of motor neurons in the spinal ventral horn. To investigate the motoneuron death after avulsion injury in rats, the intradural root avulsion procedure is usually used, although it is technically demanding and associated with a risk of unexpected spinal cord damage. We have developed a new cervical nerve root avulsion procedure in rats and investigated the validity of our procedure. METHODS Our procedure is using a posterior approach and pulling the C6 nerve root outside the vertebral foramen without intradural procedures. The lateral third of the lateral mass is needed to be resected before pulling the nerve root. The accomplishment of our procedure is judged by confirmation of the bifurcated stump of the avulsed nerve root and the leakage of the spinal fluid from vertebral foramen. At first, four Sprague-Dawley (SD) rats were used for the examination of C6 motor neuron distribution in the normal spinal cord. Then, 40 SD rats were divided into following four groups and the survival rate of motor neuron was examined. (A) an intradural avulsion group, (B) an intradural rhizotomy group, (C) our extravertebral avulsion group, and (D) an extravertebral rupture group. Another 26 SD rats were used for the examination of histomorphorogic changes in the spinal cord after our extra-vertebral avulsion procedure. RESULTS At 28 days after injury, the percentage of surviving motor neurons in groups A (39.0 ± 2.1%) and C (47.5 ± 7.1%) were significantly lower than those in groups B (77.1 ± 12.3%) and D (98.9 ± 9.9%). Compared with other groups, our procedure was easier and associated with less unexpected spinal cord damage. Although the length of the distal stump of the extravertebrally avulsed ventral rootlets was varied between 1.5 and 3.2 mm, this difference did not affect motoneuron death. The extravertebral avulsion injury showed intraspinal bleeding along the motoneuron axons, glial reaction and macrophage infiltration in the lesioned side of the ventral horn. CONCLUSIONS Our extravertebral avulsion procedure is simple and reproducible. It would become a useful tool for the study of cervical nerve root avulsion injury.
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Affiliation(s)
- Takashi Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto City, Kyoto 606-8507, Japan.
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Kakinoki R, Ohta S, Noguchi T, Kaizawa Y, Itoh H, Duncan SF, Matsuda S. A MODIFIED TENSION BAND WIRING TECHNIQUE FOR TREATMENT OF THE BONY MALLET FINGER. ACTA ACUST UNITED AC 2013; 18:235-42. [DOI: 10.1142/s0218810413500299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: To report the outcomes of mallet fractures treated with our modified tension band wiring technique. Methods: Eleven men and two women (mean age; 33 years) with mallet fractures in which happened more than five weeks before surgery, or with fracture fragments involving more than 2/3 or less than 1/3 of the distal phalanx articular surface or with previous surgical intervention, were subjected to this study. The fracture fragment was fixed with a modified tension band wiring technique using a stainless steel wire and an injection needle. Results: All patients achieved bone union in nine weeks in average. All patients had no pain except one with mild pain. No patient showed a gap or step-off greater than 1 mm. Conclusions: Our tension band wiring technique can be used regardless of the size of the dorsal fracture fragment or the interval between injury and surgery.
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Affiliation(s)
- Ryosuke Kakinoki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
- Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto 606-8570, Japan
| | - Soichi Ohta
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Takashi Noguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Hiromu Itoh
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Scott F. Duncan
- Department of Orthopedic Surgery, Ochsner Health System, Central, LA 70818, USA
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
- Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto 606-8570, Japan
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