Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

A left ventricular (LV) free wall rupture is a highly lethal condition. A 75-year-old female who experienced chest pain was diagnosed as having an acute aortic dissection Stanford type A and underwent emergent surgery. Under cardiopulmonary bypass with LV venting through the right superior pulmonary vein, a proximal aortic stamp was formed. The patient was cooled, selective antegrade brain perfusion was performed, and a hemiarch repair was performed. After the patient was transferred to the intensive care unit, her blood pressure suddenly fell to 50 mmHg. She had a blowout rupture in the left ventricular anterolateral free wall. Since the bleeding hall was not large and the damage to the surrounding left ventricular tissue was not very wide, an off-pump multilayered sutureless repair was performed by using three layers of collagen fleece squares with fibrinogen-based impregnation (TachoComb;CSL Behring, Tokyo, Japan) and three layers of gelatin-resorcin-formalin glue reinforced by an equine pericardial patch (Xenomedica;Edwards Lifesciences, LLC, Irvine, CA). The blow-out rupture seemed to be caused by perioperative myocardial infarction generated by the compression of the left ventricular vent to the LV lateral wall. The patient was free from re-rupture or aneurysm enlargement. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

In situ Injectable Tetra-PEG Hydrogel Bioadhesive for Sutureless Repair of Gastrointestinal Perforation

Hydrogel bioadhesives represent promising and efficient alternatives to sutures or staples for gastrointestinal(GI)perforation management.However,several concerns remain for the existing bioadhesives including slow and/or weak adhesive,poor mechanical strength,low biocompatibility,and poor biodegradability,which largely limit their clinical application in GI perforation repair.In this work,we introduce an in situ injectable Tetra-PEG hydrogel bioadhesive(SS)composed of tetra-armed poly(ethylene glycol)amine(Tetra-PEG-NH2)and tetra-armed poly(ethylene glycol)succinimidyl succinate(Tetra-PEG-SS)for the sutureless repair of GI defects.The SS hydrogel exhibits rapid gelation behavior and high burst pressure and is capable of providing instant robust adhesion and fluid-tight sealing in the ex vivo porcine intestinal and gastric models.Importantly,the succinyl ester linkers in the SS hydrogel endow the bioadhesive with suitable in vivo degradability to match the new GI tissue formation.The in vivo evaluation in the rat GI injured model further demonstrates the successful sutureless sealing and repair of the intestine and stomach by the SS hydrogel with the advantages of neglectable postsurgical adhesion,suppressed inflammation,and enhanced angiogenesis.Together,our results support potential clinical applications of the SS bioadhesive for the high-efficient repair of GI perforation.

A“T.E.S.T.”hydrogel bioadhesive assisted by corneal cross-linking for in situ sutureless corneal repair

Corneal transplantation is an effective clinical treatment for corneal diseases,which,however,is limited by donor corneas.It is of great clinical value to develop bioadhesive corneal patches with functions of“Transparency”and“Epithelium&Stroma generation”,as well as“Suturelessness”and“Toughness”.To simultaneously meet the“T.E.S.T.”requirements,a light-curable hydrogel is designed based on methacryloylated gelatin(GelMA),Pluronic F127 diacrylate(F127DA)&Aldehyded Pluronic F127(AF127)co-assembled bi-functional micelles and collagen type I(COL I),combined with clinically applied corneal cross-linking(CXL)technology for repairing damaged cornea.The patch formed after 5 min of ultraviolet irradiation possesses transparent,highly tough,and strongly bio-adhesive performance.Multiple cross-linking makes the patch withstand deformation near 600%and exhibit a burst pressure larger than 400 mmHg,significantly higher than normal intraocular pressure(10-21 mmHg).Besides,the slower degradation than GelMA-F127DA&AF127 hydrogel without COL I makes hydrogel patch stable on stromal beds in vivo,supporting the regrowth of corneal epithelium and stroma.The hydrogel patch can replace deep corneal stromal defects and well bio-integrate into the corneal tissue in rabbit models within 4 weeks,showing great potential in surgeries for keratoconus and other corneal diseases by combining with CXL.

Dual-crosslinked regenerative hydrogel for sutureless long-term repair of corneal defect

Corneal transplantation is the most effective clinical treatment for corneal defects,but it requires precise size of donor corneas,surgical sutures,and overcoming other technical challenges.Postoperative patients may suffer graft rejection and complications caused by sutures.Ophthalmic glues that can long-term integrate with the corneal tissue and effectively repair the focal corneal damage are highly desirable.Herein,a hybrid hydrogel consisting of porcine decellularized corneal stroma matrix(pDCSM)and methacrylated hyaluronic acid(HAMA)was developed through a non-competitive dual-crosslinking process.It can be directly filled into corneal defects with various shapes.More importantly,through formation of interpenetrating network and stable amide bonds between the hydrogel and adjacent tissue,the hydrogel manifested excellent adhesion properties to achieve suture-free repair.Meanwhile,the hybrid hydrogel not only preserved bioactive components from pDCSM,but also exhibited cornea-matching transparency,low swelling ratio,slow degradation,and enhanced mechanical properties,which was capable of withstanding superhigh intraocular pressure.The combinatorial hydrogel greatly improved the poor cell adhesion performance of HAMA,supported the viability,proliferation of corneal cells,and preservation of keratocyte phenotype.In a rabbit corneal stromal defect model,the experimental eyes treated with the hybrid hydrogel remained transparent and adhered intimately to the stroma bed with long-term retention,accelerated corneal re-epithelialization and wound healing.Giving the advantages of high bioactivity,low-cost,and good practicality,the dual-crosslinked hybrid hydrogel served effectively for long-term suture-free treatment and tissue regeneration after corneal defect.

经结膜入路不缝合骨膜的眼眶骨折修复术疗效观察

目的:探索经结膜入路不缝合骨膜修复眼眶骨折的手术方法的临床效果和临床可行性。方法:本研究采用回顾性调查,包括单纯性眶壁骨折51例,复合型骨折21例。采用经下睑结膜切口或经泪阜切口。探查并还纳嵌顿组织,根据骨折特点,采用羟基磷灰石复合材料或钛板、钛网修复眼眶骨折。所有病例均不缝合骨膜,结膜对合后,应用可吸收缝线缝合3针,然后缝合外眦韧带。观察术后各种并发症,包括结膜愈合状况;植入物暴露、感染和移位;外眦畸形;下睑退缩等。结果:所有病例术后平均随访4～18(平均11)mo,结膜切口愈合良好。其中3例出现外眦畸形,1例出现下睑内翻倒睫伴下睑退缩。无1例出现植入物暴露、感染和移位。结论:经结膜入路不缝合骨膜的眼眶骨折修复术术后发生并发症的几率较低,且无严重并发症,可以将该技术应用于单纯性和复合型骨折的临床修复。

法洛四联症根治术中左肺动脉狭窄的处理

目的:总结合并左肺动脉狭窄的法洛四联症(TOF)不同手术处理方法及随访结果。方法:回顾性分析2011年1月至2017年12月间,合并左肺动脉狭窄的TOF根治手术49例结果。患儿男性22例,女性27例,年龄7~71个月,平均19. 5个月,体质量6. 5~20. 8 kg,平均(10. 9±4. 8) kg。对于左肺动脉狭窄采用三种不同的处理方法:①常规心包补片加宽(31例)、②无线缝合心包补片加宽(10 例)、③不加宽(8例)。观察术后早期及中远期随访情况。结果:死亡2例(病死率4.1%)。超声心动图随访5~75个月,平均(27. 2±13. 6)个月,患儿肺动脉均有不同程度生长,左肺动脉压差较术前减轻。常规心包加宽组、无线缝合组及不加宽组左肺动脉处仍各有3例(9. 7%)、2例(20%)及4例(50%)存在明显压差。结论:左肺动脉狭窄影响TOF根治术结果。心包补片加宽修补左肺动脉狭窄结果满意,无线缝合适用于重度肺动脉狭窄患儿。

人工硬脑膜材料的研究现状

在神经外科手术中,硬脑膜替代物对于维持解剖学的完整和脑组织保护是十分重要的。近年来,随着组织工程和生物材料研究技术的发展,人工硬脑膜的研究取得许多进展。本文对人工硬脑膜国内外的相关文献进行了检索和综合分析,并展望了未来人工硬脑膜研究重点和发展方向。

Sutureless技术矫治新生儿完全性肺静脉异位引流单中心应用体会

目的总结应用Sutureless技术矫治完全性肺静脉异位引流(total anomalous pulmonary ve-nous connection,TAPVC)新生儿的相关经验。方法纳入2008年1月至2015年12月间在我院运用su-tureless技术行TAPVC矫治术的新生儿42例,男31例,女11例,中位年龄8.0天。TAPVC心上型25例(59.5%),心下型17例(40.5%)。记录术中和术后体外循环、主动脉阻断、肺静脉流速等相关临床数据。结果术后死亡1例。术后无肺静脉狭窄(PVO)发生,随访肺静脉狭窄1例。再入院患儿6例,原因分别为败血症、伤口愈合不良、支气管肺炎和不完全性肠梗阻。结论Sutureless技术为TAPVC新生儿的外科矫治带来可观的预后,显著降低了患儿术后病死率和PVO再发率。