Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy

Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux and a large (≥8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (≤11 months) the patients are doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement of the repair with PTFE mesh. Received: 5 March 1996/Accepted: 3 June 1996     

A New Device for Endothelial Cell Seeding of a Small-Caliber Vascular Prosthesis

Abstract: A device permitting homogeneous endothelial cell seeding of a small-calíber arteríal prosthesís has been developed. The prosthesis is maintained firmly attached to a rotative scaffolding device. This device is activated by an electrical motor at constant and adjustable speed. The whole system is maintained at 37°C in a cell culture incubator. The 4 mm internal diameter polytetrafluoroethylene (PTFE) prosthesis was coated with biological glue and seeded with human saphenous vein endothelial cells obtained by mechanical detachment. Cell seeding density was 2.10⁴ cells/cm² (Group A, n = 6) or 10⁵ cells/cm² (Group B, n = 6). Rotation speed was 8 revolutions per hour (rph) during 90 min. Analysis of the homogeneity of cell seeding was permitted by cell counts on five different segments of the prosthesis. Each longitudinal segment was analyzed at three different subsegments of the circumference. The average adhesion was 43 ± 4% in Group A and 38%± in Group B of seeded cells. No difference could be observed between the different segments and subsegments. In the two groups, cells were spread, and in Group B, a complete endothelial cell layer was obtained on the graft surface. This study permits validation of the device to allow homogeneous cell seeding in an arterial prosthesis.     

聚四氟乙烯膜作为结膜再生引导物的临床研究

应用聚四氟乙烯膜覆盖结膜缺损,以利残存结膜再生修复缺损。治疗浆细胞瘤2例,睑球粘连5例,眼窝狭缩6例,复发性翼状胬肉3例,共16例。一般结膜缺损2～3周即可愈合,平均随访12个月,疗效稳定。提示该膜可作为结膜缺损修复过程中的再生引导物。     

The Use of Expanded Polytetrafluoroethylene (Gore-Tex) in Rhinoplasty

Background Septal cartilage still is the most appropriate graft material used in rhinoplasty. In traumatic or revision cases, septal cartilage can be insufficient, and the need for an implant material emerges. In this study, the safety and efficacy of polytetrafluoroethylene (Gore-Tex) used as an implant material in nasal dorsal augmentation were assessed. Methods This study retrospectively reviewed 74 patients who underwent nasal dorsal augmentation with Gore-Tex. Of the 74 patients who underwent rhinoplasty with Gore-Tex for dorsal augmentation from February 1999 to January 2006, 46 (62.2%) represented primary cases and 28 (37.8%) represented revision cases. The patients were followed from 5 to 62 months (average, 28 months) and questioned about cosmetic and functional outcomes. The results were assessed according to patients’ charts as well as preoperative and postoperative photographic documentation. Results There were no complications such as infections, foreign body reaction, extrusions, resorption, or migration, and all the patients were satisfied with their results. Only one case of soft tissue reaction was observed, which lasted for 3 weeks postoperatively. Conclusions Biocompatibility, ease of use, lack of extrusion or resorption, and low rate of infection make Gore-Tex a good alternative to autogenous tissue. However, long-term success and complication rates still are lacking, and large numbers of patients with longer follow-up periods are required.     

Radiologic Findings of Complicated Alloplastic Implants in the Nasal Dorsum

ObjectivesWhen performing cosmetic rhinoplasty with alloplastic materials, complications such as implant visualization, inflammation, dislocation, and extrusion should be thoroughly evaluated. Although computed tomography (CT) can provide useful information about the implant status and its interaction with the skin soft tissue envelope (SSTE), the radiologic findings of these interactions have rarely been reported.MethodsWe retrospectively reviewed the data of 80 patients who underwent facial bone CT or ostiomeatal unit CT at Asan Medical Center between July 2008 and January 2020 for the evaluation of dorsal implants with complications. We reviewed the implantation period, implant dislocation, implant curling or deformation, radiodensity (in Hounsfield units), and nasal bone changes including bone erosion or hyperostosis.ResultsOf the 80 patients, 67 (83.8%) had silicone implants and 13 (16.2%) had Gore-Tex implants. The radiologic findings of the silicone implants were as follows: maintenance of the implant shape (80.6%), radiolucency (similar density to that of fat tissue) halo (83.6%), and homogeneous attenuation (82.1%). Peri-implant calcification was often found in silicone implants with >20-year implantation periods. The findings of Gore-Tex were as follows: curling or deformation (84.6%), heterogeneous attenuation (84.6%), and consistent peri-implant calcification over time.ConclusionSilicone and Gore-Tex implants have distinctive radiologic features. These findings of alloplastic materials help us to understand how implants behave in the nasal dorsum and how they affect the SSTE.     

Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: an experimental study

One of the most common complications of lumbar spine surgery is peridural fibrosis, a fibroblastic invasion of the nerve roots and the peridural sac exposed at operation. Peridural fibrosis may produce symptoms similar to those the patient experienced preoperatively and, if another spinal operation is necessary, may increase the risk of injury at re-exposure. In a controlled study in dogs, we assessed the use of expanded polytetrafluoroethylene (ePTFE) as a barrier to postoperative invasion of fibrous tissue into the laminectomy defect. In 14 dogs, a two-level laminectomy was done, at L4-L5 and L6-L7. In 12 dogs, an ePTFE membrane was placed directly over the dorsal surface of the laminectomy defect at L4-L5 and within the defect (over the surface of the dura) at L6-L7. No material was implanted in two dogs (controls). Tissue for histologic studies was obtained from the controls and from ten dogs with the membrane 12 weeks postoperatively. Two dogs with the membrane underwent reoperation. The study found that there was no peridural fibrosis in seven of the ten specimens in which the ePTFE membrane had been placed directly on the dorsal surface of the laminectomy defect, some peridural fibrosis in all specimens in which the membrane had been placed within the defect, and extensive fibrosis in controls. The ePTFE membrane created an excellent plane of dissection for reoperation. No foreign-body reactions to the membrane or membrane-related infections occurred. We conclude that the ePTFE spinal membrane, when properly implanted, is an effective barrier to postsurgical fibrous invasion of the vertebral canal. Clinical studies of use of this material in spinal surgery are warranted. Received: 24 November 1997 Revised: 26 November 1998 Accepted: 2 December 1998