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Christopher D Murawski - One of the best experts on this subject based on the ideXlab platform.
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incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations comparison between osteotomy versus Soft Tissue procedures
Knee Surgery Sports Traumatology Arthroscopy, 2018Co-Authors: Christopher D Murawski, Youichi Yasui, Khushdeep S Vig, Ichiro Tonogai, Chun Wai HungAbstract:There is a lack of substantial clinical evidence endorsing the clinical outcomes of osteotomy for peroneal tendon dislocations. The aim of this study was to compare the post-operative reoperation rates following osteotomy techniques and Soft Tissues procedures using large database in order to investigate the efficacy of bony techniques. Patients who underwent osteotomy and Soft Tissue procedures for peroneal tendon dislocations were identified and subsequently analysed using the United Healthcare Orthopedic and the Medicare datasets (PearlDiver Patient Record Database, PearlDiver Technologies Inc., Fort Wayne, IN). The investigated period was from 2005 to 2012. The annual incidence, gender distribution, and incidences of reoperation and wound dehiscence following primary operative procedures were determined in these cohorts. Of 6122 patients who received operative treatment for peroneal tendon dislocations, 1416 patients (23.1%) received the osteotomy technique, while 4706 (76.9%) were treated with the Soft Tissue techniques. The incidence of these operative procedures did not change significantly over the time periods of each database. In both databases, reoperation rates were 2.8% (40/1416) for osteotomy patients and 3.4% (158/4706) for Soft Tissue Repair patients, with no statistical difference (2.8 vs. 3.4%. odds ratio 0.8, 95% confidence interval [CI] 0.6–1.2, [n.s.]) between them. Based on both databases, wound dehiscence occurred in 2.6% (37/1416) of the osteotomy patients and 2.3% (110/4706) of Soft Tissue Repair patients with no statistical difference (2.6 vs. 2.3%, odds ratio 1.1, 95% CI 0.8–1.6, [n.s.]) between the groups. The results of this study show that osteotomy techniques were frequently performed for patients with peroneal tendon dislocations. Nevertheless, osteotomy techniques for peroneal tendon dislocations are not associated with a lower risk of reoperation. In conclusion, Soft Tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates. III.
Youichi Yasui - One of the best experts on this subject based on the ideXlab platform.
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incidence of reoperation and wound dehiscence in patients treated for peroneal tendon dislocations comparison between osteotomy versus Soft Tissue procedures
Knee Surgery Sports Traumatology Arthroscopy, 2018Co-Authors: Christopher D Murawski, Youichi Yasui, Khushdeep S Vig, Ichiro Tonogai, Chun Wai HungAbstract:There is a lack of substantial clinical evidence endorsing the clinical outcomes of osteotomy for peroneal tendon dislocations. The aim of this study was to compare the post-operative reoperation rates following osteotomy techniques and Soft Tissues procedures using large database in order to investigate the efficacy of bony techniques. Patients who underwent osteotomy and Soft Tissue procedures for peroneal tendon dislocations were identified and subsequently analysed using the United Healthcare Orthopedic and the Medicare datasets (PearlDiver Patient Record Database, PearlDiver Technologies Inc., Fort Wayne, IN). The investigated period was from 2005 to 2012. The annual incidence, gender distribution, and incidences of reoperation and wound dehiscence following primary operative procedures were determined in these cohorts. Of 6122 patients who received operative treatment for peroneal tendon dislocations, 1416 patients (23.1%) received the osteotomy technique, while 4706 (76.9%) were treated with the Soft Tissue techniques. The incidence of these operative procedures did not change significantly over the time periods of each database. In both databases, reoperation rates were 2.8% (40/1416) for osteotomy patients and 3.4% (158/4706) for Soft Tissue Repair patients, with no statistical difference (2.8 vs. 3.4%. odds ratio 0.8, 95% confidence interval [CI] 0.6–1.2, [n.s.]) between them. Based on both databases, wound dehiscence occurred in 2.6% (37/1416) of the osteotomy patients and 2.3% (110/4706) of Soft Tissue Repair patients with no statistical difference (2.6 vs. 2.3%, odds ratio 1.1, 95% CI 0.8–1.6, [n.s.]) between the groups. The results of this study show that osteotomy techniques were frequently performed for patients with peroneal tendon dislocations. Nevertheless, osteotomy techniques for peroneal tendon dislocations are not associated with a lower risk of reoperation. In conclusion, Soft Tissue procedures offer a satisfactory method of treating peroneal tendon dislocations without any additional risk of reoperation when compared to osteotomy techniques that have potentially greater complication rates. III.
Paul M. Pellicci - One of the best experts on this subject based on the ideXlab platform.
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posterior Soft Tissue Repair after primary tha is durable at mid term followup a prospective mri study
Clinical Orthopaedics and Related Research, 2015Co-Authors: Alexander S Mclawhorn, Hollis G Potter, Michael B Cross, Friedrich Boettner, Weiyang Lim, Yuoyu Lee, Paul M. PellicciAbstract:Background The enhanced posterior Soft Tissue Repair has reduced the frequency of dislocation after primary THA performed through the posterolateral approach. However, the long-term integrity of the Repair is unknown and could influence surgeon choice regarding surgical technique and THA approach.
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Review: posterior Soft Tissue Repair in primary total hip arthroplasty.
HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 2006Co-Authors: F. Bottner, Paul M. PellicciAbstract:IntroductionThe posterior approach is the most common approach usedin the United States. Its main advantages include (1) lessextensive Tissue dissection, (2) better visualization of theacetabulum, (3) lower incidence of heterotopic boneformation, and (4) preservation of the abductor mechanism.Historically, the posterior approach in primary total hiparthroplasty (THA) was associated with an increased riskof postoperative dislocation compared to the anterolateralor the transtrochanteric approach [1–3]. The senior author(P.M.P.) has described a posterior Soft Tissue Repairreattaching the short external rotators and the posteriorcapsule to the greater trochanter. This Repair has subse-quently resulted in a significant reduction of the risk ofpostoperative dislocation [4]. The current review describesthe surgical technique used by the senior author anddiscusses alternative techniques, biomechanical founda-tions, and the clinical outcome of patients undergoingprimary THA thorough a posterior approach with SoftTissue Repair.Surgical techniqueThe patient is positioned in the lateral decubitus positionfor a standard posterior approach. Through a straightposterior incision, the fascia lata and the gluteus maximusmuscle are identified. It is the philosophy of the seniorauthor (P.M.P.) to use an adequate incision length becausea meticulous Repair will require good exposure. Currentlythe average incision length is about 6 in.The fascia lata is incised and the gluteus maximus isfinger-split along its fibers. A Charnley retractor is insertedto improve visualization of the posterior capsule and shortexternal rotators. Using electrocautery, the posterior fatTissue and remnants of the bursa are divided, therebypreserving a layer of Tissue that later can be closed over theshort external rotators. Proximally, the posterior boarder ofthe gluteus medius, and, distally, the proximal boarder ofthe quadratus femoris muscle are identified. The piriformistendon is palpated and a thin, bent Hohmann retractor isinserted over the tendon between the gluteus medius andminimus to expose the short external rotators (Fig. 1).Distally, an Aufranc retractor is inserted between thequadratus femoris muscle and the distal part of theposterior capsule. Successively the hip is positioned ininternal rotation to improve the access to the insertion ofthe piriformis and conjoined tendon. Considering that bothtendons are inserted in the piriformis fossa further anteriorthan is generally expected, it is important to release thetendon as close to its anatomic position as possible. Thiswill preserve maximum tendon length for a later tension-free Repair. At its anatomic insertion the piriformis andconjoined tendon (common insertion of inferior gemellus,superior gemellus, and obturator internus muscle) willmerge to form a single wide tendon belly. As long as twoseparate tendons are released, it is likely that the tendonwas cut far away from its insertion site in the piriformisfossa. As soon as the tendon is released, two no. 2Ethibond sutures are looped through the short externalrotator tendons twice, and the tendons are pulled posteriorto expose the posterior capsule (Fig. 2). Then, the posteriorboarder of the gluteus minimus muscle is identified and aperiosteal elevator is slit between the muscle and theposterior capsule. As soon as the gluteus minimus iselevated off the posterior capsule, the thin bent Hohmannretractor is repositioned underneath it, and the posteriorcapsule is incised. Using an electrocautery, the capsuleincision is started at the 1o’clock position and descendsanteriorly toward the greater troachanter. It is important tostart the incision proximally because this part of the
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posterior approach to total hip replacement using enhanced posterior Soft Tissue Repair
Clinical Orthopaedics and Related Research, 1998Co-Authors: Paul M. Pellicci, Mathias P G Bostrom, Robert PossAbstract:The two senior authors (PMP, RP) independently began using an identical enhanced posterior Soft Tissue Repair after total hip replacement through a posterior approach. In the first author's experience, a dislocation rate of 4% in 395 patients before using the enhanced closure was reduced to 0% in 395 patients in whom the enhanced closure was performed. In the second author's experience, 160 total hip replacements had a dislocation rate of 6.2% before the enhanced closure whereas 124 total hip replacements had a dislocation rate of 0.8% after the enhanced closure. These results are highly statistically significant.
Guy Voeller - One of the best experts on this subject based on the ideXlab platform.
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characterization of host response resorption and strength properties and performance in the presence of bacteria for fully absorbable biomaterials for Soft Tissue Repair
Hernia, 2017Co-Authors: Nathaniel Stoikes, Corey R Deeken, Jeffrey R Scott, Amit Badhwar, Guy VoellerAbstract:Purpose The objective was to evaluate the host response, resorption, and strength properties, and to assess the performance in the presence of bacteria for Phasix™ Mesh (Phasix™) and Gore® Bio-A® Tissue Reinforcement (Bio-A®) in preclinical models.
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characterization of host response resorption and strength properties and performance in the presence of bacteria for fully absorbable biomaterials for Soft Tissue Repair
Hernia, 2017Co-Authors: Nathaniel Stoikes, Corey R Deeken, Jeffrey R Scott, Amit Badhwar, Guy VoellerAbstract:The objective was to evaluate the host response, resorption, and strength properties, and to assess the performance in the presence of bacteria for Phasix™ Mesh (Phasix™) and Gore® Bio-A® Tissue Reinforcement (Bio-A®) in preclinical models. In a rat model, one mesh (2 × 2 cm) was implanted subcutaneously in n = 60 rats. Animals were euthanized after 2, 4, 8, 12, 16, or 24 weeks (n = 5/mesh/time point), and implant sites were assessed for host inflammatory response and overall fibrotic Repair thickness. In a rabbit model, meshes (3.8 cm diameter) were bilaterally implanted in subcutaneous pockets in n = 20 rabbits (n = 10 rabbits/mesh) and inoculated with 108 CFU clinically isolated methicillin-resistant Staphylococcus aureus (MRSA). One mesh type was implanted per animal. Animals were euthanized after 7 days, and implants were assessed for abscess formation, bacterial colonization, and mechanical strength. In the rat study, Phasix™ and Bio-A® exhibited similar biocompatibility, although Bio-A® demonstrated a significantly greater inflammatory response at 4 weeks compared to Phasix™ (p < 0.01). Morphometric analysis demonstrated rapid resorption of Bio-A® implants with initially thicker Repair sites at 2, 4, 8, and 12 weeks (p < 0.0001), which transitioned to significantly thinner sites compared to Phasix™ at 16 and 24 weeks (p < 0.0001). In the rabbit bacterial inoculation study, Phasix™ exhibited significantly lower abscess score (p < 0.001) and bacterial colonization (p < 0.01), with significantly greater mechanical strength than Bio-A® (p < 0.001). Host response, resorption, Repair thickness, strength, and bacterial colonization suggest a more stable and favorable outcome for monofilament, macroporous devices such as Phasix™ relative to multifilament, microporous devices such as Bio-A® over time.
Jeffrey R Scott - One of the best experts on this subject based on the ideXlab platform.
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characterization of host response resorption and strength properties and performance in the presence of bacteria for fully absorbable biomaterials for Soft Tissue Repair
Hernia, 2017Co-Authors: Nathaniel Stoikes, Corey R Deeken, Jeffrey R Scott, Amit Badhwar, Guy VoellerAbstract:The objective was to evaluate the host response, resorption, and strength properties, and to assess the performance in the presence of bacteria for Phasix™ Mesh (Phasix™) and Gore® Bio-A® Tissue Reinforcement (Bio-A®) in preclinical models. In a rat model, one mesh (2 × 2 cm) was implanted subcutaneously in n = 60 rats. Animals were euthanized after 2, 4, 8, 12, 16, or 24 weeks (n = 5/mesh/time point), and implant sites were assessed for host inflammatory response and overall fibrotic Repair thickness. In a rabbit model, meshes (3.8 cm diameter) were bilaterally implanted in subcutaneous pockets in n = 20 rabbits (n = 10 rabbits/mesh) and inoculated with 108 CFU clinically isolated methicillin-resistant Staphylococcus aureus (MRSA). One mesh type was implanted per animal. Animals were euthanized after 7 days, and implants were assessed for abscess formation, bacterial colonization, and mechanical strength. In the rat study, Phasix™ and Bio-A® exhibited similar biocompatibility, although Bio-A® demonstrated a significantly greater inflammatory response at 4 weeks compared to Phasix™ (p < 0.01). Morphometric analysis demonstrated rapid resorption of Bio-A® implants with initially thicker Repair sites at 2, 4, 8, and 12 weeks (p < 0.0001), which transitioned to significantly thinner sites compared to Phasix™ at 16 and 24 weeks (p < 0.0001). In the rabbit bacterial inoculation study, Phasix™ exhibited significantly lower abscess score (p < 0.001) and bacterial colonization (p < 0.01), with significantly greater mechanical strength than Bio-A® (p < 0.001). Host response, resorption, Repair thickness, strength, and bacterial colonization suggest a more stable and favorable outcome for monofilament, macroporous devices such as Phasix™ relative to multifilament, microporous devices such as Bio-A® over time.
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characterization of host response resorption and strength properties and performance in the presence of bacteria for fully absorbable biomaterials for Soft Tissue Repair
Hernia, 2017Co-Authors: Nathaniel Stoikes, Corey R Deeken, Jeffrey R Scott, Amit Badhwar, Guy VoellerAbstract:Purpose The objective was to evaluate the host response, resorption, and strength properties, and to assess the performance in the presence of bacteria for Phasix™ Mesh (Phasix™) and Gore® Bio-A® Tissue Reinforcement (Bio-A®) in preclinical models.
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evaluation of the antimicrobial efficacy of a novel rifampin minocycline coated noncrosslinked porcine acellular dermal matrix compared with uncoated scaffolds for Soft Tissue Repair
Surgical Innovation, 2016Co-Authors: Arnab Majumder, Jeffrey R Scott, Yuri W NovitskyAbstract:Background Despite meticulous aseptic technique and systemic antibiotics, bacterial colonization of mesh remains a critical issue in hernia Repair. A novel minocycline/rifampin tyrosine-coated, noncrosslinked porcine acellular dermal matrix (XenMatrix AB) was developed to protect the device from microbial colonization for up to 7 days. The objective of this study was to evaluate the in vitro and in vivo antimicrobial efficacy of this device against clinically isolated methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli. Methods XenMatrix AB was compared with 5 existing uncoated Soft Tissue Repair devices using in vitro methods of zone of inhibition (ZOI) and scanning electron microscopy (SEM) at 24 hours following inoculation with MRSA or E coli These devices were also evaluated at 7 days following dorsal implantation and inoculation with MRSA or E coli (60 male New Zealand white rabbits, n = 10 per group) for viable colony-forming units (CFU), abscess formation and histopathologic response, respectively. Results In vitro studies demonstrated a median ZOI of 36 mm for MRSA and 16 mm for E coli for XenMatrix AB, while all uncoated devices showed no inhibition of bacterial growth (0 mm). SEM also demonstrated no visual evidence of MRSA or E coli colonization on the surface of XenMatrix AB compared with colonization of all other uncoated devices. In vivo XenMatrix AB demonstrated complete inhibition of bacterial colonization, no abscess formation, and a reduced inflammatory response compared with uncoated devices. Conclusion We demonstrated that XenMatrix AB possesses potent in vitro and in vivo antimicrobial efficacy against clinically isolated MRSA and E coli compared with uncoated devices.