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I Introduction. In generalizing the experience of providing medical care to the wounded in armed conflicts, a special place belongs to the analysis of the magnitude and structure of casualties, which depend on the conditions, forms and methods of hostilities. The purpose. Conduct a clinical and epidemiological analysis of the proportion of gunshot and mine injuries in the structure of combat surgical trauma during the Anti-terrorist operation / Joint Forces operation. Materials and methods. The total number of wounded as a result of the armed conflict in eastern Ukraine in the period from 2014 to 2019 was more than 41 thousand people, from them killed among the civilian population – 3350 people and 4100 – servicemen. Results. It was proved that the wounded with non-severe combat surgical trauma are 36.5%, severe – 48.9%, extremely severe – 14.6%. Shrapnel wounds were received by 35.3%, bullet wounds – 48.3%, mine injuries – 16.6%. Isolated combat surgical trauma was found in 16.8%, multiple – in 34.3%, combined – in 48.9% of the wounded. Impenetrable combat surgical trauma was diagnosed in 63.7% of the wounded, penetrating into the pleural cavity – in 17.2%, in the abdominal cavity – in 16.0%, in the pelvic cavity – in 3.1%. Conclusions. In the structure of sanitary losses of the surgical profile during the ATO / OOS, the wounded with injuries of the extremities are 56.7%, with injuries of the chest – 10.1%, abdomen – 5.1%, pelvis – 3.0%.

STUDY DESIGN Preclinical study in rodents. OBJECTIVE To investigate changes in biomechanical properties of paraspinal muscles following a posterior spinal surgery in an animal model. SUMMARY OF BACKGROUND DATA Posterior spine surgery damages paraspinal musculature per histological and imaging studies. The biomechanical effects of these changes are unknown. METHODS 12 Sprague-Dawley rats were divided equally into sham and surgical injury (SI) groups. For sham, the skin and lumbodorsal fascia were incised at midline. For SI, the paraspinal muscles were detached from the vertebrae, per normal procedure. Thirteen weeks postsurgery, multifidus and longissimus biopsies at L1, L3, and L5 levels were harvested on the right. From each biopsy, three fibers and three to six bundles of fibers (∼10-20 fibers ensheathed in their extracellular matrix) were tested mechanically to measure their passive elastic modulus. The collagen content and fatty infiltration of each biopsy were also examined histologically by immunofluorescence staining. Nonparametric statistical methods were used with a 1.25% level of significance. RESULTS A total of 220 fibers and 279 bundles of fibers were tested. The elastic moduli of the multifidus and longissimus fibers and longissimus fiber bundles were not significantly different between the SI and sham groups. However, the elastic modulus of multifidus fiber bundles was significantly greater in the SI group compared to sham (SI median 82 kPa, range 23-284; sham median 38 kPa, range 23-50, P = 0.0004). The elastic modulus of multifidus fiber bundles in the SI group was not statistically different between spinal levels (P = 0.023). For histology, only collagen I deposition in multifidus was significantly greater in the SI group (median 20.8% vs. 5.8% for sham, P

Objectives: Canine retraction was accelerated by periodontal distraction or several surgical techniques depending on the concept that the greater surgical injury to alveolar bone, the greater biological response in the form of localized inflammatory reaction and bone remodeling, hence tooth movement acceleration. The present study aimed to compare between certain surgical techniques and periodontal distraction combined with interseptal bone reduction to accelerate canine distalization.Patients and Methods: A randomized split mouth clinical multi-operator study was performed on 30 orthodontic patients aged 15 years and above whose treatment procedures were planned for first premolar extractions and subsequent retraction of canines. Canines were distalized by surgery or distraction on one side and by conventional mechanics on the other side (the control side). Subjects were randomized equally into three canine retraction groups: Group I (multiple-osteoperforation MOPs); Group II (MOPs+corticotomy) and Group III (periodontal distraction). Canine retraction was carried out by power chain applying 150 g of force per side. Total time for complete canine retraction was determined and change in canine angulation was assessed using panoramic radiographs.Results: Regarding the time needed for complete canine retraction for all groups, the experimental side(surgical or distraction) showed a statistically significant lower mean value as compared with the non-surgical side. In other words, less than three months in Group I, about two months in Group II and less than one month in Group III, while more than four months in the conventional retraction side was taken for complete canine retraction. the mean canine angulation changes by degree was (11-15.2-23.2-8.1) degree for group I, II III and conventional group respectively.Conclusion: Canine retraction movement was accelerated effectively by MOPs, corticotomy and periodontal distraction techniques; the fastest of them was the periodontal distraction mechanics. However, it showed more distal tipping and more buccal inclination of the canine than MOPs, corticotomy or conventional canine retraction.

Focal defects in the annulus fibrosus (AF) of the intervertebral disc (IVD) arising from herniation have detrimental impacts on the IVD's mechanical function. Thus, biomimetic-based repair strategies must restore the mechanical integrity of the AF to help support and restore native spinal loading and motion. Accordingly, an annulus fibrosus repair patch (AFRP); a collagen-based multi-laminate scaffold with an angle-ply architecture has been previously developed, which demonstrates similar mechanical properties to native outer AF (oAF). To further enhance the mimetic nature of the AFRP, interlamellar (ILM) glycosaminoglycan (GAG) was incorporated into the scaffolds. The ability of the scaffolds to withstand simulated impact loading and resist herniation of native IVD tissue while contributing to the restoration of spinal kinematics were assessed separately. The results demonstrate that incorporation of a GAG-based ILM significantly increased (p 0.001) the impact strength of the AFRP (2.57 ± 0.04 MPa) compared to scaffolds without (1.51 ± 0.13 MPa). Additionally, repair of injured functional spinal units (FSUs) with an AFRP in combination with sequestering native NP tissue and a full-thickness AF tissue plug enabled the restoration of creep displacement (p = 0.134), short-term viscous damping coefficient (p = 0.538), the long-term viscous (p = 0.058) and elastic (p = 0.751) damping coefficients, axial neutral zone (p = 0.908), and axial range of motion (p = 0.476) to an intact state. Lastly, the AFRP scaffolds were able to prevent native IVD tissue herniation upon application of supraphysiologic loads (5.28 ± 1.24 MPa). Together, these results suggest that the AFRP has the strength to sequester native NP and AF tissue and/or implants, and thus, can be used in a composite repair strategy for IVDs with focal annular defects thereby assisting in the restoration of spinal kinematics.

Objective: To investigate the effects of the mechanical trauma to the round window, a model electrode inserted into the scala tympani on the cochlear reserve, and the efficacy of topical steroids in preventing hearing loss. Materials and Methods: 21 male Wistar Albino rats were equally categorized into three groups. In all groups an initial mechanical injury to round window was created. Only subsequent dexamethasone injection was administrated into the cochlea in the subjects of group 2 while a multichannel cochlear implant guide inserted into the cochlea prior to dexamethasone administration for group 3. Distortion product otoacoustic emissions (DPOAEs) were obtained prior to and immediately after the surgical injury, eventually on postoperative seventh day (d 7). Mean signal/noise ratios (S/Ns) obtained at 2000, 3000, and 4000 Hz were calculated. Data sets were compared with non-parametric statistical tests. Results: The early intraoperative mean S/Ns were significantly less than preoperative measurements for group 1 and 2; however, preoperative and postoperative d 7 average S/Ns did not differ. There was statistically significant difference between preoperative, intraoperative and postoperative d 7 average S/Ns for group 3. Conclusion: We observed that hearing was restored approximately to the preoperative levels following early postoperative repair. However, an electrode insertion into the cochlea via round window subsequent to mechanical trauma seems to cause a progressive hearing loss. Therefore, a special care must be taken to avoid the injury to the round window membrane in the course of the placement of a cochlear implant electrode and surgery for the chronic otitis media.

Objective To determine the effect of alveolar decortication on orthodontically induced root resorption. Materials and Methods A total of 24 male Wistar rats (14 week old) were used. The rats were randomly divided into one of the following three groups: group 1 (control group), orthodontic tooth movement (OTM) for 2 weeks; group 2, OTM for 2 weeks + two alveolar decortications (2AD); group 3, OTM for 2 weeks + four alveolar decortications (4AD). The first molar was moved mesially for 2 weeks. Micro computed tomography was used to analyze root volume. In addition, histological sections were stained with Tartrate Resistant Acid Phosphatase (TRAP) to quantify the osteoclast number. Results The buccal root volume in OTM + 4AD group was decreased by 8.92% and 6.11% when compared with the OTM-only group and OTM + 2AD group, respectively. Similarly, the other four root volumes in the OTM + 4AD group was decreased by 8.99% and 5.24% when compared with the OTM-only group and OTM + 2AD group, respectively. There was a decrease in buccal root density in the OTM + 4AD group by 4.66% and 3.56% when compared with the OTM-only group and the OTM + 2AD group, respectively. In addition, there was an increase in the number of osteoclasts by 195.73% and 98.74% in OTM + 4AD group in comparison with the OTM and OTM + 2AD group. Conclusions The amount of orthodontically induced root resorption was positively correlated with the extent of surgical injury used to accelerate orthodontic tooth movement.

The paper describes a method for three-dimensional printing of сustom-made interbody cages accounting for biomechanical parameters of the intervertebral disc (anteroposterior size, anterior and posterior disc heights), which provides the implant with unique characteristics. An example of using custom-made cages providing optimal conditions for the formation of interbody bone-metal block due to the extra tight fit of the combined implant is given. It is shown that custom-made cages have a beneficial effect on the spine support recovery time, significantly reduce the surgical injury, and shorten the time of surgery. The manufacturing of each developed implant which has its own form and architecture is not a serial but a piece production not requiring additional registration procedure. The use of custom-made spinal cages allows optimizing the process of surgical treatment and improving short- and medium-term results.

Postoperative paralysis of the vocal cords resulting from intraoperative surgical injury of the recurrent laryngeal nerve is one of the most serious complications of elective thyroid surgery. The chance of injury is reduced by using intraoperative neuromonitoring (IONM). This educational report describes a case of IONM failure resulting from residual muscle relaxation that was restored by administration of sugammadex. It discusses possible pharmacology explanations and provides recommendations for how to prevent this situation in daily practice.

This study provides novel insight into the process by which surgical injury places the intestinal epithelium at risk for colonization by pathogenic microbes and impairment of its regenerative capacity via loss of its microbiota. We show that fecal transplant restores crypt homeostasis in association with repopulation of the microbiota within cecal crypts., Cecal crypts represent a unique niche that are normally occupied by the commensal microbiota. Due to their density and close proximity to stem cells, microbiota within cecal crypts may modulate epithelial regeneration. Here we demonstrate that surgical stress, a process that invariably involves a short period of starvation, antibiotic exposure, and tissue injury, results in cecal crypt evacuation of their microbiota. Crypts devoid of their microbiota display pathophysiological features characterized by abnormal stem cell activation as judged by leucine-rich repeat-containing G protein-coupled receptor 5 (Lgr5) staining, expansion of the proliferative zone toward the tips of the crypts, and an increase in apoptosis. In addition, crypts devoid of their microbiota display loss of their regenerative capacity as assessed by their ability to form organoids ex vivo. When a four-member human pathogen community isolated from the stool of a critically ill patient is introduced into the cecum of mice with empty crypts, crypts become occupied by the pathogens and further disruption of crypt homeostasis is observed. Fecal microbiota transplantation restores the cecal crypts’ microbiota, normalizes homeostasis within crypts, and reestablishes crypt regenerative capacity. Taken together, these findings define an emerging role for the microbiota within cecal crypts to maintain epithelial cell homeostasis in a manner that may enhance recovery in response to the physiological stress imposed by the process of surgery. NEW & NOTEWORTHY This study provides novel insight into the process by which surgical injury places the intestinal epithelium at risk for colonization by pathogenic microbes and impairment of its regenerative capacity via loss of its microbiota. We show that fecal transplant restores crypt homeostasis in association with repopulation of the microbiota within cecal crypts.

Pancreatic tumors and their surgical resection are associated with significant morbidity and mortality, and the biomarkers currently used for these conditions have limited sensitivity and specificity. Because calprotectin and calgranulin C serum levels have been demonstrated to be potential biomarkers of certain cancers and complications of major surgery, the levels of both proteins were tested in the current study in patients with benign and malignant pancreatic tumors that were surgically removed. The baseline serum levels and kinetics of calprotectin and calgranulin C during the 7-day postoperative period were evaluated with immunoassays in 98 adult patients who underwent pancreatic surgery. The baseline serum levels of calprotectin and calgranulin C in patients with malignant (n=84) and benign tumors (n=14) were significantly higher (p<0.01) when compared to those in the healthy controls (n=26). The serum levels of both proteins were also significantly (p<0.05) higher in patients with benign tumors than in those with malignant tumors. After surgery, the serum levels of calprotectin and calgranulin C were significantly (p<0.01) higher than their baseline values, and this elevation persisted throughout the seven days of the follow-up period. Interestingly, starting on day 1 of the postoperative period, the serum levels of both proteins were significantly (p<0.05) higher in the 37 patients who developed postoperative pancreatic fistulas (POPFs) than in the patients who had uneventful recoveries (n=61). Moreover, the serum levels of calprotectin and calgranulin C demonstrated a significant predictive value for the development of POPF; the predictive values of these two proteins were better than those of the serum level of C-reactive protein and the white blood cell count. Taken together, the results of this study suggest that calprotectin and calgranulin C serum levels are potential biomarkers for pancreatic tumors, surgical injury to the pancreatic tissue and the development of POPFs.

Background: Although pleurodesis is usually used to reduce the recurrence rate for primary spontaneous pneumothorax (PSP) in surgery, existing techniques cannot meet the higher requirements of little surgical injury and less relapse. Hence, we developed a new pleurodesis technique and named multipoint pleura cautery. Aim: In this study, we aimed to investigate the effectiveness and outcomes of the uniportal video-assisted thoracoscopic surgery C-shaped pleura cautery in the surgical treatment of PSP. To the best of our knowledge, this is a new surgical technique for pleurodesis and must be of concern. Patients and Methods: The medical records of 20 patients undergoing surgery for C-shaped pleura cautery between 2015 and 2017 were reviewed. The patients were evaluated with regard to age, gender, body mass index, smoking habit, operation time, duration of hospitalization, post-operative pain and follow-up. Results: We have performed a bullectomy combined C-shaped pleura cautery for 20 patients with PSP from January 2016 to December 2017. None of the patients suffered post-operative bleeding and haematothorax complications, and one was ipsilateral relapsed 5 months after surgery. The lung computed tomography showed that recurrence of pneumothorax was due to air leakage in the right lower lung, and there was no air leakage at the site where pleurodesis had been performed. Conclusions: Although this technique requires further investigation, it may be a useful method of pleurodesis.

Objective The purpose of this investigation was to evaluate the therapeutic efficacy of superpulsed, low-level laser therapy (SLLLT) on neurosensory recovery of the inferior alveolar nerve (IAN) after oral surgical injury. Background data A survey of the literature reveals the uncertainty of outcomes for the surgical management of IAN injury and the efficacy of low-level laser therapy in the treatment of IAN injury. Methods In this study, the authors report the results for SLLLT in 57 patients affected by paresthesia of the lip, chin, gingival, and buccal regions. Each patient was subjected to 10 laser treatments, once a week, with a GaAs diode laser. Clinical neurosensory tests (soft touch, 2-point discrimination, pin prick, thermal test) and the visual analogue scale were used before every treatment to evaluate the extent of neurosensory recovery. Results The authors' results demonstrate that 83.3% of the patients had a significant neurosensory recovery, as evident in the objective and subjective tests. Conclusion The results reported in this study indicate that SLLLT has the potential to improve neurosensory recovery in patients with IAN paresthesia.

Overshooting trocar insertion in Iaparoscopic surgery has been extensively cited as a major cause of surgical injury. The complexity and extensive insertion force required of the current handheld insertion method increases the risk of overshooting and is difficult for novice and female operators. Hence, we developed a trocar insertion device to make the procedure easier and safer. The device is designed so it is easy to handle and assemble. It used negative pressure and pneumatic cylinders to lift the abdominal wall and two motors to drive the trocar insertion. In addition, we interpreted the characteristics of the insertion force and developed an algorithm to detect whether the trocar is properly inserted. By monitoring changes in the insertion force with this device, the trocar insertion can be stopped automatically and immediately. The development of this device has realized the automation of trocar insertion. It reduces the demand on operators and improves the safety of the procedure.

Recent work utilizing ultrasound imaging demonstrated that individuals with low back pain (LBP) have increased thickness and decreased mobility of the thoracolumbar fascia (TLF), an indication that the TLF may play a role in LBP. This study used a porcine injury model (microsurgically induced local injury)—shown to produce similar results to those observed in humans with LBP—to test the hypothesis that TLF mechanical properties may also be altered in patients with LBP. Perimuscular TLF tissue was harvested from the noninjured side of vertebral level L3-4 in pigs randomized into either control (n = 5) or injured (n = 5) groups. All samples were tested with a displacement-controlled biaxial testing system using the following protocol: cyclic loading/unloading and stress relaxation tests at 25%, 35%, and then 45% of their resting length. Tissue anisotropy was also explored by comparing responses to loading in longitudinal and transverse orientations. Tissues from injured pigs were found to have greater stretch–stretch ratio moduli (measure of tissue stiffness), less energy dissipation, and less stress decay compared to tissues from control pigs. Responses across these variables also depended on loading orientation. Clinical significance: these findings suggest that a focal TLF injury can produce impairments in tissue mechanical properties away from the injured area itself. This could contribute to some of the functional abnormalities observed in human LBP.

Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic–based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. What’s New As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.

Fifteen years ago, laparoscopic surgery of rectal cancer was considered as radical in terms of oncology as open surgery. A trend to reduce surgical injury may be observed in surgery in recent years. In this paper the first experience in the new minimally invasive method of anterior rectal resection is described – through the transanal way. The procedure duration was 130 min. The use of transanal access in rectal cancer surgery is undoubtedly an alternative method to standard laparoscopic surgery. In patients with a large tumour in the lower rectum, the technique allows a longer rectal stump to be left below the resection border.

Purpose: To evaluate the efficacy of the application of the human amniotic membrane (HAM) on the inflammatory process, fibroblast proliferation, formation of collagenand reduction of skin wound areas in rats. Methods: Thirty six rats were submitted to a surgical injury induction and divided into two groups (n = 18): group C (control) and T (treated with the HAM). The macroscopic evolution in the wound area and the histological characteristics of the skin samples were evaluated. Results: The regression of the wound area was greater in group T. The histological analysis revealed a significant reduction (p < 0.05) in the inflammatory infiltrate in group T at all experimental periods compared with that in the control group. Furthermore, the group T presented a significant increase in the proliferation of fibroblasts at 14 and 21 days compared with group C (p < 0.05). Regarding the deposition of mature collagen fibers, there was an increase in the replacement of type III collagen by type I collagen in group T (p < 0.05). Conclusion: Treatment with the HAM reduced the healing time as well as the inflammatory responses, increased the proliferation of fibroblasts, and induced a higher concentration of mature collagen fibers.

Adhesion of freely moving tissues and organs due to surgical injury and trauma can be a serious postoperative complication. High rates of incidence due to surgical intervention, especially associated with abdominal procedures, have been reported. This chapter gives an introduction to the formation of adhesions, with particular focus on peritoneum, urinary and reproductive (female) systems, tendon, ligament, joint, and pericardium. A number of techniques, treatments, and materials have been proposed for the prevention/reduction of adhesion formation. Of these, barrier methods are considered the only effective method currently available. An overview of biomaterials currently used as barriers for postsurgical tissue adhesion is presented. Current clinical practice utilizes solid membranes/mechanical barriers, spray-on, and gel and liquid barriers. These barriers can be either resorbable, nonresorbable, or a combination of both. Complications of barrier films are examined, and design criteria for barrier membranes are presented. Adhesion formation can be beneficial in particular circumstances, such as for anchoring implants, and these uses are commented upon. Much advancement has been made in this area, thanks to the increasing knowledge and understanding regarding the events that control adhesion formation, but there is still a long way to go before an optimum solution to this problem is found.

Facial synkinesis is the simultaneous contraction of the certain facial musculature accompanying a motion of designated muscle in the face. With the exception of rare afflictions that are congenital in origin, most patients develop as a sequel to facial nerve paralysis due to trauma, tumor, and surgical injury. As an idiopathic congenital form, oculo-nasal synkinesis which reveals co-contraction of orbicularis oculi and the compressor narium minor muscles which are innervated by separate branches of the facial nerve have been already reported. In addition to oculo-nasal synkinesis, the authors describe 2 more rare patients with facial synkinesis; oculo-zygomatic and fronto-nasal synkinesis with video documentation, which to the best of our knowledge, have not been reported previously in detail. This will help plastic surgeons prevent being involved in legal issues when they might neglect these rare phenomena in preoperative evaluation during cosmetic surgery.

A pseudoaneurysm (false aneurysm) develops when all three walls of an artery (intima, media, and adventitia) are violated. In the sellar region, pseudoaneurysms of the internal carotid artery (ICA) usually occur iatrogenically as a result of surgical injury.

Disturbed flow patterns, material mismatch, and surgical injury are often cited as being significant contributors to failure at the distal end of femoropopliteal bypass grafts. The objective of this research is to propose a novel bypass graft design concept which seeks to reduce the incidence of disturbed flow in the bypass junction and to establish the surgical feasibility of the proposed device. A preliminary evaluation of the hemodynamic benefit associated with the proposed device was made using computational fluid dynamics. A prototype of the device was then constructed from commercially available materials, and it was prepared for implantation into the aorta of a pig. The computational model of the proposed device showed that significant flow correction was occurring in the in vitro model due to the geometric configuration of the design. The magnitude of the peak wall shear stress in the recirculation region was noted to decrease by 78%. Surgical feasibility of the proposed device was verified by successful implantation into the aorta of the pig. The pig was sacrificed after 7 weeks, the graft and host artery were excised, and histological examination downstream from the distal junction showed that intimal hyperplasia had developed in the host artery. The proposed device is surgically feasible and may offer a significant hemodynamic advantage over current graft designs.

Highlights • Laparoscopic gastrectomy had satisfactory results in patients with gastric cancer. • Natural orifice surgery (NOS) is an ever-evolving advanced laparoscopic technique. • NOS promises minimizing surgical injury, less wound complications and faster recovery. • Laparoscopy plus NOS can potentiate the advantages of both minimal invasive techniques. • We presented a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy., Purpose Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. Case A 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. Conclusions Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo–radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.

The exact frequency and clinical consequences of surgical hepatic injuries during organ procurement are unknown. We analyzed the incidence, risk factors, and clinical outcome of surgical injuries in 241 adult liver grafts. Hepatic injuries were categorized as parenchymal, vascular, or biliary. Outcome variables were bleeding complications, hepatic artery thrombosis (HAT), and graft survival. In 82 livers (34%), 96 injuries were detected. Most injuries were minor, but clinically relevant injuries were detected in 6.6% (16/241) of the livers. Fifty (21%) liver grafts had some degree of parenchymal or capsular injury, 40 (17%) had vascular injury, and 6 (2%) had an injury to the bile duct. Procurement region was the only risk factor significantly associated with surgical injury. The rate of hepatic artery injury was significantly higher in livers with aberrant arterial anatomy. Bleeding complications were found in 18% of patients who received livers with a parenchymal or capsular injury in contrast to 9% without parenchymal injury (P = 0.065). HAT was found in 23% of the patients who received a liver with arterial injury compared to 4% without arterial injury (P = 0.001). Overall graft survival rates were not significantly different for grafts with or without anatomical injury. In conclusion, surgical injuries of donor livers are an underestimated problem in liver transplantation and can be observed in about one-third of all cases. Clinically relevant injuries are detected in 6.6% of all liver grafts. Arterial injuries are associated with an increased risk of HAT.

Summary This study seeks to determine the ability of enzyme-linked immunosorbent assays (ELISAs) of vocal fold secretions to detect and describe the acute tissue response to injury in a rabbit vocal fold model. Vocal fold secretions were collected before the induction of a unilateral surgical injury to the vocal fold and at 6 timepoints after injury (1, 5, 7, 10, 14, and 21 days). Secretions were then subjected to ELISAs to assess concentrations of interleukin-1 beta (IL-1β) and prostaglandin-E2 (PGE-2). The results indicate that ELISAs may be useful in documenting fluctuations in these markers associated with the wound healing process in the rabbit model. The temporal expression of both IL-1β and PGE-2 was consistent with their proposed roles in the wound healing cascade in other systems, pointing to the potential that surface secretions may be at least partial indicators of wound healing events within the tissue.

Background. The precise incidence and cause of atrioventricular block (AVB) after heart transplantation remain uncertain. Methods and Results. After surgery, immediate and follow-up electrocardiograms from 1,047 consecutive patients who underwent heart transplantation were reviewed for AVB and correlated with clinical symptoms, laboratory data, rejection grade, and echocardiogram and coronary angiography findings. A total of 113 patients demonstrated various kinds of AVB; the incidence was 10.8%. First-degree AVB occurred in 87 patients, 37 of whom also demonstrated persistent atrial tachyarrhythmias (ATAs). In 30 patients, first-degree AVB occurred 7 days to 120 months after heart transplantation. Among those, 88% demonstrated cellular rejection, and 20% developed transplant coronary artery disease (TCAD). Fifty patients demonstrated first-degree AVB without ATA, 32 of whom developed AVB from operative day 7 to 156 months. The incidence of cellular rejection was significantly lower (36%, P

Lower urinary tract storage and voiding dysfunction are known to occur after radical hysterectomy [1]. Up to 50 % of patients who undergo radical hysterectomy experience at least one urinary tract symptom over a variable period of time [2]. This is probably due to a decrease in musculo-elastic properties of the bladder wall caused by surgical injury and partial damage to the autonomic innervation of the bladder [3]. Lower urinary tract rehabilitation may be offered to these patients including pelvic floor training, behavioral modification, electrical stimulation, and clean intermittent self-catheterization [4]. In the last years, posterior tibial nerve stimulation (PTNS) has become an alternative treatment for voiding dysfunction before proceeding towards more invasive surgical procedures. Van Balken et al. [5] and Vandonick et al. [6] were the first to report the benefit of PTNS in patients with idiopathic nonobstructive voiding dysfunction. However, the literature lacks studies evaluating the effect of PTNS on chronic voiding dysfunction secondary to radical hysterectomy. Here, we report a case that suffered from chronic voiding dysfunction and urinary incontinence for 8 years after radical hysterectomy and treated with PTNS.

Background: Minimally invasive esophagectomy has been developed to reduce surgical injury. In this current study, we have designed a new operative procedure to dissect the esophagus with less chest injury. Methods: Three pigs (Sus domesticus) underwent the same procedures: routine laparoscopic techniques, anastomosis at left neck and right thoracoscopic everted esophagectomy utilizing one thoracoscopic operative hole. Results: The everted resection of the esophagus was successfully accomplished in the three pigs utilizing one thoracoscopic operative hole. Conclusions: A novel technique was described here. The procedure of the operation was modified with anastomosis operated before esophagectomy. Only one thoracic operative hole was needed, which reduced the injury on chest wall.

PURPOSE: To compare the biomodulatory effects of LED and ultrasound combined with semipermeable dressing in the repair of cutaneous lesions.METHODS:Eighty-four Wistar rats were submitted to surgical injury (2.5 cm) and divided into four groups (n=21): Group I (control), Group II (LED therapy, LED), Group III (LED therapy + dressing, LED+D) and Group IV (ultrasound + dressing, US+D). At seven, 14 and 21 days, the animals were euthanized, and the specimens of interest removed for histological analysis.RESULTS:Histological and histomorphometric analysis revealed a greater percent wound regression in animals receiving the dressing (group III: 55.97; group IV: 53.06), as well as a greater reduction in the inflammatory infiltrate (group III: 29.14; group IV: 31.71) since day 7. A later effect, with progression of the tissue repair process only after 14 and 21 days, was observed in the LED group intense fibroblast proliferation and greater collagen fiber production and organization were seen in the LED+D and US+D groups compared to the other groups.CONCLUSION:LED combined with a dressing was more effective at accelerating in the repair of cutaneous lesions.

Regenerative mechanisms after surgical injury have been studied in many organs but not in the kidney. Studying surgical injury may provide new insights into mechanisms of kidney regeneration. In rodent models, extrarenal tissues adhere to surgical kidney wound and interfere with healing. We hypothesized that this can be prevented by wrapping injured kidney in a plastic pouch. Adult rats tolerated 5/6 nephrectomy with pouch application well. Histological analysis demonstrates that application of the pouch effectively prevented formation of adhesions and induced characteristic wound healing manifested by formation of granulation tissue. Additionally, selected tubules of the wounded kidney extended into the granulation tissue forming branching tubular epithelial outgrowths (TEOs) without terminal differentiation. Tubular regeneration outside of renal parenchyma was not previously observed, and suggests previously unrecognized capacity for regeneration. Our model provides a novel approach to study kidney wound healing.

Degradable magnesium alloys are promising biomaterials for orthopedic applications. The aim of this study was to evaluate the potential effects on both the synovial membrane (synovialis) and the synovial fluid (synovia) of the degradation products of a MgYREZr-pin implanted in the intercondylar femoral notch in a rabbit model. Thirty-six animals were randomized into two groups (MgYREZr or Ti6Al4V alloy) of 18 animals each. Each group was then divided into three subgroups with implantation periods of 1, 4, and 12 weeks, with six animals in each subgroup. The initial inflammatory reaction caused by the surgical trauma declined after 12 weeks of implantation, and elucidated a progressive recovery of the synovial membrane. Compared with control Ti6Al4V pins, there were no significant differences between the groups. However, after 12 weeks, recovery of the synovial membrane was more advanced in the titanium group, in which 92% showed no signs of synovitis, than in the magnesium group. A cytotoxicity test with L929 cells and human osteoblasts (HOB) was also conducted, according to EN ISO 10993-5/12, and no toxic leachable products were observed after 24 h of incubation. In conclusion, the MgYREZr alloy seems to be a suitable material for intra-articular degradable implants. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Atomic force microscopy (AFM) was used to comparatively study the structure of the bone matrix of rat tibia from an intact region with that from regions submitted to surgical injury. We used young male adult rats (Wistar), with corporal masses between 250 and 300 g. Each injury was provoked by drilling a 1.5-mm-diam hole in one cortical tibia surface. The healing course was monitored at 8 and 15 days after the injury. Atomic force microscopy images, at different magnifications, allowed the identification of the time dependence of the osteoblast activity, measured by the increase in the area of neoformed primary bone and in the organization of the collagen fibers of the bone matrix. Characterization of the natural recovery of the damaged bone tissue by AFM is potentially of great importance because it allows the comparison of natural recovery processes with those induced by medicines and other therapeutic procedures.

The content of basic fibroblast growth factor (bFGF) and also interleukins 1β and 6 (IL-1β and IL-6) has been investigated in rat buccal mucosa after its surgical injury by an erbium laser (Er:YAG laser) and a scalpel. The laser emission caused a sharp increase in the content of these regulators on the second day after treatment followed by decrease observed on the seventh day. These results may reflect synergistic effect of these peptide regulators in the wound defect. Changes in time-course of bFGF, IL-1β and IL-6 release in the wound formed by the laser beam compared with the wound induced by the cutting instrument may promote earlier appearance of the proliferation phase.

T IS WELL KNOWN that mechanical tissue njury, such as surgical trauma, causes reease of chemical mediators which lower he response threshold for firing of A-delta nd C-fibers and increases the magnitude of he pain response at the site of injury. This s nociception, the pathway of normal pain ransmission and sensation. However, reent studies have demonstrated that nocieptive input from the surgical injury can licit an increased response from the dorsal orn neurons in the spinal cord (central ensitization). This heightened response rom the spinal cord may explain, in part, hy pain can occur after nonpainful stimuli uch as pressure and touch, and why pain ith movement or activity after surgery is reater than pain at rest.

Surgical treatment of the Tetralogy of Fallot (ToF) is one of the great successes of medicine and also a topic of controversy. Different strategies have been proposed, including age-based (neonatal) management strategies as well as anatomic-based management strategies. Regardless of the management strategy entailed, the surgical management of ToF has considerably evolved over the years. As a result, patients can now expect excellent early results with survival approaching 100% for those without genetic syndromes. The goals of current surgical therapy should be to mitigate the late right ventricular (RV) dysfunction that may occur by minimizing the extent of surgical injury during the intial repair. As the surgical techniques continue to advance, the outcomes will continue to improve.

Scarring of the vocal folds is commonly caused by surgical injury or high impact voice use. As the by-product of the tissue healing in response to the injury, scarring involves a plethora of cells and chemicals whose interactions are dynamic and non-linear (Li et al, 2011). A thorough understanding of the wound healing process is needed. The ability to model cellular interactions using computer simulations constitutes the first step towards patient specific treatments of vocal fold injuries.

Persistent post-operative pain is characterized by hyperalgesia and allodynia. Both nociceptor and spinal cord sensitization are implicated in this form of neuroplasticity. In animal models it has been demonstrated that this sensitization can be prevented by the prophylactic use of analgesics (pre-emptive analgesia). However, a number of clinical studies in man have failed to confirm a significant pre-emptive analgesic effect in the modern surgical setting. The possible reasons for this failure of correlation between the animal and human studies are discussed.

Treatment of anterior cruciate ligament (ACL) tears in growing youths has evolved considerably over the past decade. There is a growing trend toward operative stabilization, because studies show the risks of not treating these injuries. We have gained experience on techniques that reduce the risk of surgical injury to the growing physis. Even for the complete tear of the ACL, controversies continue. Is there any role for nonoperative care? Is it safe to cross an open physis and before or after what age? How do we best determine skeletal maturity and remaining growth potential? Which “physeal-sparing” procedures best reproduce the native anatomy and therefore normal mechanics? Although the quantity and quality of scientifically sound information available to us limits our ability to be definitive, this article addresses the reliable scientific data that is available as well as expert experience and opinion. Published data regarding partial ACL injury, particularly in youths, are limited and opinions differ regarding diagnosis and treatment. The partial ACL injury debate starts with the fundamentals of definition and diagnosis, which makes the process of providing the patient with informed conclusions and treatment algorithms challenging. Nevertheless, partial injuries are a reality and clinical decisions must be made based on the sound principles and the best available data.

Adhesion of freely moving tissues and organs due to surgical injury and trauma can be a serious postoperative complication. High rates of incidence due to surgical intervention, especially associated with abdominal procedures, have been reported. This chapter gives an introduction to the formation of adhesions, with particular focus on peritoneum, urinary and reproductive (female) systems, tendon, ligament, joint, and pericardium.

Incontinence and impotence are the two chief drawbacks of radical prostatectomy (RP). Incontinence is the most relevant for most of the patients, even if there is high variability in terms of prevalence and definition of continence. Incontinence seems the result of several factors, the most important being the surgical injury of some structures and the biomechanical instability associated with vesicourethral anastomosis. In the posterior urethra, which guarantees the continence mechanism, two functionally independent regions can be recognized: the proximal and the distal. The proximal region can be identified with the bladder neck, while the distal region is the rhabdosphincter urethrae. Concerning the distal functional region, two kinds of strategy can be applied: the preservation of puboprostatic ligaments and urethral attachments, or the reconstruction of the urethral rhabdosphincter, which can be anterior, posterior or total. We describe our technique of choice for posterior reconstruction, first described by Rocco and then modified by Patel et al.

Ten women had endometriosis and pelvic peritoneal defects of the posterior leaf of the broad ligament, with the consistent finding of medial displacement of the ureter toward the uterosacral ligament. Ureterolysis at the time of surgery revealed the underlying course of the ureter and its proximity to the uterosacral ligament, making it susceptible to surgical injury. It is important for surgeons to be aware of this anatomic alteration associated with these specific peritoneal defects.

The system chose the Visualization Toolkit and Visual C++ as the development platform. The coronal section and the sagittal section were reconstructed through the crosssection of patients thoracic computed tomography (CT). Analyzing of these slices, the doctor can discover the position of tumors. And then the three-dimensional (3-D) reconstruction of the chest and the tumors can be reconstructed by the volume rendering Ray-Casting method. The position of incision surgery can be located by the position of tumors, which would help the doctor analysis and view tumors and 3-D reconstruction of the chest from any angle through graphical visual interfaces in the computer. The surgical injury could be minimized.

Transient post-tonsillectomy taste dysgeusia (PTD) is a common complaint. Long-lasting PTD is less frequent but has significant consequences on patients' quality of life, with some cases leading to medicolegal issues. Treatment options and knowledge about mechanisms and factors favoring PTD are limited. PTD may result from direct surgical injury, tongue compression, inflammatory processes or side effects of local anesthetics. Some authors also claim that dietary zinc deficiency plays a role in the development of PTD. Although this latter cause had not yet received a lot of attention, we report a case of a female patient who reported a 4-year PTD and recovered within 2 months after oral intake of zinc sulfate. This clinical observation, together with recent findings on significant improvement of taste disorders after zinc treatments for other causes, opens again the question of what extent zinc deficiency plays a role in PTD.

The effect of occlusal alteration upon healing of the periodontium after surgical injury was studied in 62 male Wistar rats, nine weeks of age. An osteotomy was made with a bur through the vestibular bone plate, the periodontal ligaments and into the superficial part of the root surface of the first mandibular molar. In the same session, the occlusion of the antagonistic tooth was altered in the experimental groups by either placing a high amalgam restoration, grinding, or extraction. The occlusion in the control group was unaltered. The rats were killed 70 days after surgery, and examined histologically. A histometric registration of the periodontal repair revealed a significant narrowing of the periodontal ligament width in the non-occluding teeth, as well as significant thickening of cementum at and above the surgical cavity site. The hypo- and hyper-occluding teeth did not show significant changes as compared to the controls.

Objectives1) Understand the changing etiologies of unilateral vocal cord paralysis. 2) Learn the frequency of return of vocal cord function after paralysis.MethodsWe performed a retrospective analysis of 280 patients treated in the Department of Otolaryngology at the University of Miami for the diagnosis of unilateral vocal cord paralysis from 1999 to 2007. Medical records were reviewed in order to ascertain the etiology of the paralysis and determine on follow-up if there was recovery of function.ResultsThe majority of cases (46%) were of surgical origin, with the leading surgical injury being thyroid surgery. Despite a thorough workup, 28% of cases remained idiopathic in origin. 21 patients (7%) had recovery of vocal fold function, the majority of which had a surgical etiology.ConclusionsThe most common cause of unilateral vocal cord paralysis, in our experience, is surgery, with thyroid surgery being the leading cause. A large majority of these cases remain idiopathic in nature. A small subset of patie...

There has traditionally been less concern regarding coronary anomalies with left-sided congenital heart lesions such as hypoplastic left heart syndrome (HLHS)or Shone complex than with other lesions. However, coronary anomalies in this setting can profoundly affect surgical intervention, particularly when surgical repair involves the ascending aorta. We describe four patients with congenital left-sided heart lesions in which left coronary artery (LCA) anomalies substantially affected intervention and outcome. In the first two cases, the coronary anomalies were not identified prospectively and resulted in surgical injury directly to the coronary or to its surrounding region. In the latter two cases, successful identification of the coronary anomaly preoperatively allowed for modification of surgical technique and/or intervention. We conclude that detailed coronary artery assessment should be part of the routine echocardiographic evaluation of congenital left-sided heart lesions that require surgery.

We report three clinical cases in which Dupuytren’s disease was triggered by surgical trauma. All patients developed the contracture between 3 weeks and 3 months after operation for unrelated / pathology of the hand. They had significant swelling of the hand postoperatively, preventing full mobilization. They did not have a strong diathesis for the disease. Since the appearance of the contracture, they have not developed the disease in the contralateral hand or anywhere else in the body. In one case, a similar operation on the contralateral hand has not provoked onset of the disease.

Objective. Iatrogenic surgical injury to large blood vessels in the abdomen or pelvis is a rare adverse event but may be lethal. We present a new technique to repair serious vascular injury using a free graft of omentum or fascia as an overlay autogenous tissue (OAT) patch. Methods. Repair to venous and arterial defects was made using an OAT patch of omentum or rectus abdominis sheath sutured through the patch and the adventitia of the injured vessel at four sites. The technique was tested in 33 repairs in an experimental sheep model. Results. Thirty-three patch repairs were attempted and all were successfully completed. Twenty-one (64%) patches were controlled by the patch alone, and adjuvant local pressure was required in 12 (36%) cases. Conclusion. We have demonstrated that an OAT patch can be used to control vascular injury in the experimental sheep model. This technique may be useful to all surgeons especially those operating in the pelvis where there may be restricted access to repair vascular injury.

Objective: This study evaluates some “intrinsic risk factors” for a surgical injury of the external branch of superior laryngeal nerve (EBSLN) based on its anatomic relationship with the thyroid gland. Study Design and Setting: Seventy-two neck dissections were performed in 36 fresh human adult cadavers. Every EBSLN was dissected and categorized using Cernea's classification. All data regarding gender, ethnicity, stature, side of the neck, and volume of hemi thyroid were collected and statistically analyzed by the χ 2 -test and analysis of variance. Results: Although no statistical differences were observed between genders ( P = 0.3770), ethnicities ( P = 0.9780) or sides of the neck ( P = 0.2523), statistical significance was reached regarding the nerve type when the groups were divided by stature ( P = 0.0006) and glandular volume ( P = 0.0007). Conclusion: Individual stature and volume of the hemi thyroid gland are probably involved in risk of the surgical EBSLN injury. Significance: Surgeons should be aware of these anatomic findings in order to obtain a good voice-related outcome in the thyroidectomies. (Otolaryngol Head Neck Surg 2003;128:396-400.)

— Some divergencies in the literature about periodontal healing after surgical injury stimulated the development of this experiment. The root canals of dogs' teeth were negotiated and filled by the lateral condensation technique with two kinds of sealers: Sealapex and zinc oxide-eugenol cement. In the second session, the bone tissue was exposed and one cabity was made at the apical third of the root and another at the border between the coronal and middle thirds, both penetrating into the root canal. Six months later the animals were sacrificed and the specimens prepared for histopathologic analysis. The results showed that the kind of filling material and the level of the periodontal wound exposing the root canal can influence the healing process (P

Two cases of intra-oral pleomorphic adenoma with marked pseudoepitheliomatous hyperplasia of the overlying oral mucosa are reported. Incisional biopsy specimens, taken a few weeks before surgical excision of the tumor, showed no squamous cell element. Surgically excised specimens revealed pseudoepitheliomatous hyperplasia with hyperortho- and para-keratinization, which extended from overlying oral squamous epithelium, where an incisional biopsy was performed into the deep tumor area. Approximately half of the tumor area in case 1 and one-third in case 2 were occupied by hyperplastic squamous epithelium of the oral mucosa. Although the induction mechanism of such prominent pseudoepitheliomatous hyperplasia of the overlying oral mucosa occupying more than one-third of the tumor area could not be understood, it is thought that surgical injury and/or focal anesthesia during the incisional biopsy played an important role. To the best of our knowledge, these two cases represent the first reported association between benign salivary gland tumor and marked pseudoepitheliomatous hyperplasia of the overlying oral mucosa.